Document Detail


Can pregnant women be safely placed on cardiopulmonary bypass?
MedLine Citation:
PMID:  22945848     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A best evidence topic was written according to a structured protocol. The question addressed was whether cardiopulmonary bypass can be used safely with satisfactory maternal and foetal outcomes in pregnant patients undergoing cardiac surgery. A total of 679 papers were found using the reported searches of which 14 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Reported measures were maternal and foetal mortality and complications, mode of delivery, cardiopulmonary bypass and aortic cross-clamp times, perfusate flow rate and temperature and maternal NYHA functional class. The most recent of the best evidence studies, a retrospective observational study of 21 pregnant patients reported early and late maternal mortalities of 4.8 and 14.3%, respectively, and a foetal mortality of 14.3%. Median cardiopulmonary bypass and aortic cross-clamp times were 53 and 35 min, respectively, and the median bypass temperature was 37°C. Three larger retrospective reviews of the literature reported maternal mortality rates of 2.9-5.1% and foetal mortality rates of 19-29%. Mean cardiopulmonary bypass times ranged from 50.5 to 77.8 min. Another retrospective observational study reported maternal mortality of 13.3% and foetal mortality of 38.5%. Mean cardiopulmonary bypass and aortic cross-clamp times were 89.1 and 62.8 min, respectively, with a mean bypass temperature of 31.8°C. A retrospective case series reported no maternal mortality and one case of foetal mortality. Median cardiopulmonary bypass and aortic cross-clamp times were 101 and 88 min, respectively. Eight case reports described 10 patients undergoing cardiopulmonary bypass. There were no reports of maternal mortality and one report of foetal mortality. Mean cardiopulmonary bypass and aortic cross-clamp times were 105 and 50 min, respectively. We conclude that while the use of cardiopulmonary bypass during pregnancy poses a high risk for both the mother and the foetus, the use of high-flow, high-pressure, pulsatile, normothermic bypass and continuous foetal and uterine monitoring can allow cardiac surgery with the use of cardiopulmonary bypass to be performed with the greatest control of risk in the pregnant patient.
Authors:
Amir H Sepehripour; Tammy T Lo; Alex R Shipolini; David J McCormack
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-09-03
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-20     Completed Date:  2013-05-06     Revised Date:  2013-12-05    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  1063-70     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aorta / surgery
Benchmarking
Cardiac Surgical Procedures* / adverse effects,  mortality
Cardiopulmonary Bypass* / adverse effects,  mortality
Constriction
Evidence-Based Medicine
Female
Fetal Mortality
Gestational Age
Humans
Maternal Mortality
Patient Safety
Pregnancy
Pregnancy Complications, Cardiovascular / mortality,  surgery*
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2012 Dec;15(6):1070-1   [PMID:  23166221 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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