Volume 24, Issue 106, November - December, 2020

Outcomes of heart valve surgery during pregnancy: A single institute experiences

Dung H Van^1,2, Tuan M Vo^3♦, Chau NM Van⁴, Bao Vo⁵

¹Heart Institution of Ho Chi Minh City, Ho Chi Minh City, Vietnam
²University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Vietnam
³University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
⁴School of Mathematics and Statistics, Victoria University of Wellington, New Zealand
⁵University of Missouri – Kansas City, USA

^♦Corresponding author
University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam; Email: VoMinhTuan@ump.edu.vn

ABSTRACT

Objective: Cardiac surgery during pregnancy often carries a high risk of death for both mother and baby. Herein, we report our experience of valvular surgery in pregnant patients. Methods: We retrospectively reviewed the cases of all pregnant patients that had valvular surgery performed on them between 1998 and 2018 at the Ho Chi Minh City Heart Institute, Viet Nam. Both fetal and maternal outcomes have been assessed to determine the effectiveness of surgical treatment. Results: The total number of patients was 63, including 27 patients who had valvuloplasty and 36 patients who had valvular replacement. The maternal and fetal mortality rates were 4.7% and 14.3% respectively. Adverse maternal outcomes occurred in 25% of patients (n=16), including low cardiac output, cardiac arrhythmia, and acute pulmonary edema. Adverse fetal outcomes occurred in 41.2% of patients (n=26) including termination by cesarean (4), miscarriage (5), threatened abortion (12), pre-term delivery (3), and still birth (2). Factors that affect maternal mortality include pre-operative NYHA (p= 0.037) and the type of operation (p =0.034). Factors that affected fetal mortality included cardiopulmonary bypass time (p = 0.003) and clamp time (p= 0.01). The average follow-up was 103.94 ± 73.9 months (range 1- 259) with 95% completion of follow-up. Conclusions: Surgical treatment for pregnant patients with valvular heart disease remains a challenge. The coordination of many medical specialists, the use of CPB and the timing of surgery should be optimized where possible to achieve the best outcomes for both mother and fetus.

Keywords: pregnancy, valvular surgery, feto-maternal outcomes

Medical Science, 2020, 24(106), 3939-3944

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