Jing He, Wei Min, Lu Jiakai, Zhou Li, Huang Jiapeng, Cheng Weiping, Zhang Qiaoyun, Qiao Zhiyu, Zhu Junming, Ye Yingxian, Hu Jiaqi, Liang Jiexian, Wang Sheng
Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Women's Heart, Norton Heart & Vascular Institute, Louisville, KY, USA.
J Thorac Dis. 2024 Nov 30;16(11):7561-7573. doi: 10.21037/jtd-24-787. Epub 2024 Nov 11.
Cardiac surgery during pregnancy is complex and has significant risks for mothers and infants. The clinical outcomes and risk factors for complications are largely unknown. This study aimed to analyse the outcomes of cardiac surgeries during pregnancy and to investigate the risk factors for maternal postoperative outcomes from the two largest referral centres for pregnant patients with complex cardiac disease in northern and southern China.
Retrospective data review and analysis were conducted on patients who underwent cardiac surgery during pregnancy at Beijing Anzhen Hospital, Capital Medical University, and Guangdong Provincial People's Hospital from January 2010 to June 2023.
In total, 140 pregnant women underwent cardiac surgery. The maternal and foetal mortality rates were 4.3% and 35.7%, respectively. Multivariate logistic regression analysis identified preoperative left ventricular ejection fraction (LVEF), pulmonary hypertension (PH), and intraoperative blood loss as independent risk factors for postoperative new-onset cardiovascular complications or death. The combined use of these three factors yielded the highest predictive value, with the area under the curve of 0.803. A preoperative LVEF below 61.5%, PH, and intraoperative blood loss exceeding 1,150 mL can be used to predict new cardiovascular complications or death after surgery.
Cardiac surgery during pregnancy is associated with high maternal and foetal risks. Combining preoperative LVEF, PH, and intraoperative blood loss can predict postoperative cardiovascular complications and mortality reliably.
孕期心脏手术复杂，对母亲和婴儿均有重大风险。并发症的临床结局和风险因素大多未知。本研究旨在分析孕期心脏手术的结局，并调查中国北方和南方两个最大的复杂心脏病孕妇转诊中心产妇术后结局的风险因素。
对2010年1月至2023年6月在首都医科大学附属北京安贞医院和广东省人民医院接受孕期心脏手术的患者进行回顾性数据审查和分析。
共有140名孕妇接受了心脏手术。产妇和胎儿死亡率分别为4.3%和35.7%。多因素逻辑回归分析确定术前左心室射血分数（LVEF）、肺动脉高压（PH）和术中失血是术后新发心血管并发症或死亡的独立危险因素。这三个因素联合使用时预测价值最高，曲线下面积为0.803。术前LVEF低于61.5%、存在PH以及术中失血超过1150 mL可用于预测术后心血管并发症或死亡。
孕期心脏手术与产妇和胎儿的高风险相关。结合术前LVEF、PH和术中失血情况能够可靠地预测术后心血管并发症和死亡率。
