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Ann Thorac Surg 2003;76:1605-1608
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Risk factors associated with cardiac surgery during pregnancy

Renato T. Arnoni, MDa*, Antoninho S. Arnoni, MDa, Rômulo C. A. Bonini, MDa, Antônio F. S. de Almeida, MDa, Camilo A. Neto, MDa, Jarbas J. Dinkhuysen, PhDa, Mário Issa, MDa, Paulo Chaccur, MDa, Paulo P. Paulista, MDa

a Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil

Accepted for publication July 1, 2003.

* Address reprint requests to Dr Arnoni, Rua Jesuíno Arruda, 318 apto 121, Itaim Bibi, São Paulo, Brazil, CEP 04532-080
e-mail: ramoni{at}uol.com

BACKGROUND: This study is aimed at analyzing risk factors for fetal and maternal mortality in cardiac surgery during pregnancy.

METHODS: Seventy-four pregnant women underwent cardiac surgery and 58 (78.3%) were followed. The most frequent pathology was valve disease (93.2%). Mitral valve disease was the most prevalent (72.9%), and mitral commissurotomy or replacement was required in 78% of the cases. Most were in functional class III or IV and mean gestational age was 22 weeks.

RESULTS: There was functional class improvement after surgery (91% into class I or II), and 70.4% were restored to sinus rhythm. Twenty percent required reoperation. There were five maternal deaths (8.6%) and 11 fetal deaths (18.6%). Several aspects were considered as contributing risk factors for maternal mortality, such as the use of vasoactive drugs and other preoperative medications, age, kind of surgery, reoperation, and functional class. Functional class was the factor that predicted higher risk for maternal death. As to fetal mortality, several factors played a role, such as maternal age more than 35 years, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time.

CONCLUSIONS: Cardiac surgery during pregnancy is associated with acceptable maternal and fetal mortality rates. These rates may be even lower if the factors mentioned above are maintained under control.




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