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Anesthetic Management for Cardiac Surgery During Pregnancy Complicated by Postoperative Threatened Abortion

Published:October 02, 2022DOI:https://doi.org/10.1053/j.jvca.2022.09.098
      THE NEED FOR surgical intervention requiring cardiopulmonary bypass (CPB) during pregnancy poses a significant threat to the mother and the fetus. The uteroplacental response to CPB is unpredictable and results in fetal loss in up to 30% of cases.
      • Parry AJ
      • Westaby S.
      Cardiopulmonary bypass during pregnancy.
      In addition to concern for significant fetal morbidity and mortality, there are little published data to guide clinical care for these patients. Herein the authors present a case of a successful cardiac surgical intervention in a pregnant patient and discuss important considerations for such patients.

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      References

        • Parry AJ
        • Westaby S.
        Cardiopulmonary bypass during pregnancy.
        Ann Thorac Surg. 1996; 61: 1865-1869
        • Lamb MP
        • Ross K
        • Johnstone AM
        • et al.
        Fetal heart monitoring during open heart surgery. Two case reports.
        Br J Obstet Gynaecol. 1981; 88: 669-674
      1. ACOG Committee Opinion No. 775. Nonobstetric surgery during pregnancy.
        Obstet Gynecol. 2019; 133: e285-e286
        • Van Steenbergen G
        • Tsang QHY
        • Kimmenade RRJ
        • et al.
        Cardiac surgery during pregnancy: What is the optimal timing of intervention? A meta-analysis of individual patient data.
        Eur Heart J. 2020; 41 (ehaa946.3304)
        • Iscan ZH
        • Mavioglu L
        • Vural KM
        • et al.
        Cardiac surgery during pregnancy.
        J Heart Valve Dis. 2006; 15: 686-690
        • O'Neil MP
        • Fleming JC
        • Badhwar A
        • et al.
        Pulsatile versus nonpulsatile flow during cardiopulmonary bypass: Microcirculatory and systemic effects.
        Ann Thorac Surg. 2012; 94: 2046-2053
        • Dodonov M
        • Onorati F
        • Luciani GB
        • et al.
        Efficacy of pulsatile flow perfusion in adult cardiac surgery: Hemodynamic energy and vascular reactivity.
        J Clin Med. 2021; 10: 5934
        • Champsaur G
        • Parisot P
        • Martinot S
        • et al.
        Pulsatility improves hemodynamics during fetal bypass. Experimental comparative study of pulsatile versus steady flow.
        Circulation. 1994; 90: Ii47-Ii50
        • Khandelwal M
        • Rasanen J
        • Ludormirski A
        • et al.
        Evaluation of fetal and uterine hemodynamics during maternal cardiopulmonary bypass.
        Obstet Gynecol. 1996; 88: 667-671
        • Chandrasekhar S
        • Cook CR
        • Collard CD.
        Cardiac surgery in the parturient.
        Anesth Analg. 2009; 108: 777-785
        • Habib AS.
        A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia.
        Anesth Analg. 2012; 114: 377-390
        • Reitman E
        • Flood P.
        Anaesthetic considerations for non-obstetric surgery during pregnancy.
        Br J Anaesth. 2011; 107: i72-i78
        • Pomini F
        • Mercogliano D
        • Cavalletti C
        • et al.
        Cardiopulmonary bypass in pregnancy.
        Ann Thorac Surg. 1996; 61: 259-268
        • Pardi G
        • Ferrari MM
        • Iorio F
        • et al.
        The effect of maternal hypothermic cardiopulmonary bypass on fetal lamb temperature, hemodynamics, oxygenation, and acid-base balance.
        J Thorac Cardiovasc Surg. 2004; 127: 1728-1734
        • Kapoor MC.
        Cardiopulmonary bypass in pregnancy.
        Ann Card Anaesth. 2014; 17: 33-39
      2. ClinicalTrials.Gov. Oral progesterone for prevention of miscarriage in threatened abortion. Available at: https://www.clinicaltrials.gov/ct2/show/NCT04788108. Accessed June 9, 2022.

        • Mishra M
        • Sawhney R
        • Kumar A
        • et al.
        Cardiac surgery during pregnancy: Continuous fetal monitoring using umbilical artery Doppler flow velocity indices.
        Ann Card Anaesth. 2014; 17: 46-51
        • Hoyert DL.
        Maternal mortality rates in the United States, 2020.
        NCHS Health E-Stats, 2022 (Available at:) (Accessed July 23, 2022)
      3. Centers for Disease Control and Prevention. Pregnancy mortality surveillance system. Available at: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm. Accessed July 23, 2022.

        • Patel C
        • Akhtar H
        • Gupta S
        • et al.
        Pregnancy and cardiac interventions: What are the optimal management options?.
        J Card Surg. 2020; 35: 1589-1596
        • Jha N
        • Jha AK
        • Chand Chauhan R
        • et al.
        Maternal and fetal outcome after cardiac operations during pregnancy: A meta-analysis.
        Ann Thorac Surg. 2018; 106: 618-626
        • Siu SC
        • Sermer M
        • Colman JM
        • et al.
        Prospective multicenter study of pregnancy outcomes in women with heart disease.
        Circulation. 2021; 104: 515-521
        • Silversides CK
        • Grewal J
        • Mason J
        • et al.
        Pregnancy outcomes in women with heart disease: The CARPREG II study.
        J Am Coll Cardiol. 2018; 71: 2419-2430
        • Regitz-Zagrosek V
        • Roos-Hesselink JW
        • Bauersachs J
        • et al.
        2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy.
        Eur Heart J. 2018; 39: 3165-3241
        • Mehta LS
        • Warnes CA
        • Bradley E
        • et al.
        Cardiovascular considerations in caring for pregnant patients: A scientific statement from the American Heart Association.
        Circulation. 2020; 141: e884-e903
      4. ACOG Practice Bulletin No. 212. Pregnancy and heart disease.
        Obstet Gynecol. 2019; 133: e320-e356
        • Girnius A
        • Meng ML.
        Cardio-obstetrics. A review for the cardiac anesthesiologist.
        J Cardiothorac Vasc Anesth. 2021; 35: 3483-3488
      5. Hameed AB, Morton CH, Moore A. Improving health care response to cardiovascular disease in pregnancy and postpartum. Available at: https://www.cdph.ca.gov/Programs/CFH/DMCAH/RPPC/CDPH%20Document%20Library/CMQCC_CVD_Toolkit.pdf. Accessed July 23, 2022.

        • Taha B
        • Guglielminotti J
        • Li G
        • et al.
        Utilization and outcomes of extracorporeal membrane oxygenation in obstetric patients in the United States, 1999-2014: A retrospective cross-sectional study.
        Anesth Analg. 2022; 135: 268-276
        • Wong MJ
        • Bharadwaj S
        • Galey JL
        • et al.
        Extracorporeal membrane oxygenation for pregnant and postpartum patients.
        Anesth Analg. 2022; 135: 277-289
        • Shook LL
        • Barth Jr, WH
        Cardiac surgery during pregnancy.
        Clin Obstet Gynecol. 2020; 63: 429-446
        • Avila WS
        • Rossi EG
        • Ramires JA
        • et al.
        Pregnancy in patients with heart disease: Experience with 1,000 cases.
        Clin Cardiol. 2003; 26: 135-142
        • Wang A
        • Fosbøl EL.
        Current recommendations and uncertainties for surgical treatment of infective endocarditis: A comparison of American and European cardiovascular guidelines.
        Eur Heart J. 2022; 43: 1617-1625
        • Otto CM
        • Nishimura RA
        • Bonow RO
        • et al.
        2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2021; 143: e72-227
        • Habib G
        • Lancellotti P
        • Antunes MJ
        • et al.
        2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).
        Eur Heart J. 2015; 36: 3075-3128
        • Bläckberg A
        • Morenius C
        • Olaison L
        • et al.
        Infective endocarditis caused by HACEK group bacteria-a registry-based comparative study.
        Eur J Clin Microbiol Infect Dis. 2021; 40: 1919-1924
        • Berge A
        • Morenius C
        • Petropoulos A
        • et al.
        Epidemiology, bacteriology, and clinical characteristics of HACEK bacteremia and endocarditis: A population-based retrospective study.
        Eur J Clin Microbiol Infect Dis. 2021; 40: 525-534
        • Malani AN
        • Aronoff DM
        • Bradley SF
        • et al.
        Cardiobacterium hominis endocarditis: Two cases and a review of the literature.
        Eur J Clin Microbiol Infect Dis. 2006; 25: 587-595
        • Sarumathi D
        • Anitha G
        • R D
        • et al.
        A Case Report of Cardiobacterium hominis Endocarditis in a Pregnant Woman.
        Cureus. 2020; 12: e9827
        • Sen Yew H
        • Chambers ST
        • Roberts SA
        • et al.
        Association between HACEK bacteraemia and endocarditis.
        J Med Microbiol. 2014; 63: 892-895
        • Baddour LM
        • Wilson WR
        • Bayer AS
        • et al.
        Infective endocarditis: Diagnosis, antimicrobial therapy, and management of complications: A statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: Endorsed by the Infectious Diseases Society of America.
        Circulation. 2005; 111: e394-e434
        • Oliver Jr, WC
        Invited commentary.
        Ann Thorac Surg. 2018; 106: 626-627
        • Yates MT
        • Soppa G
        • Smelt J
        • et al.
        Perioperative management and outcomes of aortic surgery during pregnancy.
        J Thorac Cardiovasc Surg. 2015; 149: 607-610
        • Higgins MF
        • Pollard L
        • McGuinness SK
        • et al.
        Fetal heart rate monitoring in nonobstetric surgery: A systematic review of the evidence.
        Am J Obstet Gynecol MFM. 2019; 1100048
        • Alshawabkeh L
        • Economy KE
        • Valente AM.
        Anticoagulation during pregnancy: Evolving strategies with a focus on mechanical valves.
        J Am Coll Cardiol. 2016; 68: 1804-1813