Outcomes and risk factors for cardiac surgery during pregnancy: a 13-year, two-centre, retrospective cohort study

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.