Objectives: Cardiac disease affecting mothers is one of biggest risks of maternal death during pregnancy. However emergent cardiac surgery is rarely performed during pregnancy. Literature is demonstrating a big variety of single cases undergoing cardiac surgery during pregnancy. Here, we want to describe the outcomes after surgery during pregnancy in our single center.

Methods: We analyzed retrospectively the outcome of 18 patients, who underwent cardiac surgery during pregnancy or puerperium or underwent aortic surgery before or after pregnancy. They were treated between 1998 and 2020 at Leipzig Heart Center (Cardiac Surgery, Pediatric Cardiology, Cardiology) and Perinatal Medicine of the University Hospital.

Results: We performed 15 cardiosurgical procedures on women during pregnancy. We also treated one patient after bypass surgery because of myocardial infarction during pregnancy and 2 patients who underwent aortic surgery before and after pregnancy. In this group, 10 patients were operated  due to aortic dissection (62.5%), 2 because of myxoma (12.5%), 2 with infective endocarditis (12.5%) and one because of pulmonary embolism (6.25%).  Three patients received non-surgical treatment. In the surgery group, there were 6 women in puerperium (all in the first week) and 9 during pregnancy (mean gestational age 23 ± 12,7 weeks). Primigravida were 9, multigravida 6 patients. 2 children were delivered via naturalis, 12 children were delivered by caesarean section. The congenital disorder like Marfan and Ehlers-Danlos syndrome was known in 5/18 patients in our cohort (27.8%). We observed the following complications: maternal death was 6.25% (1 patient, Ehlers-Danlos syndrom). The perinatal mortality was 6.25 % (1 fetus). The miscarriage rate was 18.75 % (3 fetuses). Repeated cardiac surgery was performed on 3 women (2 patients with Marfan) because of renewed aortic or aortic valve disease. Postoperatively, 1 patient developed a stroke, two patients necessitated visceral surgery. There were 4 complications like re-operation related to hematothorax, stenting of descending aorta and pacemaker implantation. All complications had occurred after aortic or aortic valve surgery. One patient underwent heart transplantation because of severe heart failure after myocardial infarction.

Except for the listed 2 fatal complications, all patients and their offsprings are alive and well.

Conclusion: Cardiac surgery during pregnancy is a rare entity. It may affect mother and fetus. Major complications such as death, stroke, renewed cardiac surgery occurred in patients with aortic dissection or aortic valve disease. Patients with Marfan syndrome showed a higher risk of repeated cardiac surgery because of the underlying aortic disease. The multi-disciplinary approach and treatment of pregnant women in a timely manner may lead to a successful delivery of a healthy child without major events from the maternal side.