We read with great interest the article by Sepehripour et al. regarding the safety of performing cardiac surgery on cardiopulmonary bypass (CPB) during pregnancy [1]. They included in the results of their research three retrospective literature reviews (published in 1996 and 1998), three retrospective observational studies and eight case reports describing 10 parturients undergoing CPB. However, we found three additional relevant articles investigating the outcome of pregnancy after CBP. In order to be exhaustive, we will summarize the relevant results of the omitted papers.
Thalmann et al. [2] performed a population-based study covering a period of 10 years in Austria and found 2 pregnant patients (at 36 and 32 weeks of pregnancy) with acute aortic dissection. Emergent surgery was successful for both patients and their offspring. The relevant result of the study is that pregnancy may not be a risk factor for acute aortic dissection and hence contradicts the findings of previous studies.
Guo et al. [3] reported two cases of acute aortic dissection during the third trimester. The first was a 33-year old parturient with Marfan syndrome who underwent a successful Bentall procedure at 28 weeks of gestation, and the second was a 30-year old pregnant patient at 32 weeks of pregnancy who underwent an uneventful aortic root replacement. Both patients underwent a caesarean section immediately before CBP.
We recently reported a successful surgical pulmonary embolectomy under CBP [4]. The patient was a 39-year old at 25 weeks of pregnancy who underwent an emergent surgery due to a massive pulmonary embolism with haemodynamic compromise. In this case of heparin-induced thrombocytopenia, we chose to carry out a surgical embolectomy because we were familiar with performing this procedure when fibrinolytic therapy is contraindicated.
On the basis of accumulating evidence of encouraging results, we believe it is reasonably safe to perform cardiac surgery during pregnancy at tertiary centres with expertise using additional strategies to minimize maternal and foetal risks (normothermic CBP with high flow rate and left lateral recumbent position) [5]. The maternal mortality rate is reported to be comparable to that of CPB in non-pregnant women, except in the emergent cases. In the other hand, the foetal mortality rate decreases when cardiac surgery is postponed and the foetus is allowed to mature.
Conflict of interest: none declared
References
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