Greater understanding of heart surgery in pregnant women Research enables reduction of risks to unborn child

It is better, where possible, to postpone open-heart surgery in a pregnant woman until after delivery. This lowers the risks to the unborn child. If this is not possible, a cesarean section immediately prior to the operation can significantly increase the chances of survival of the unborn baby. This is shown in a study by the Radboudumc, the results of which have now been published in European Heart Journal. 

Pregnancy has a major impact on the cardiovascular system of women. During pregnancy, the mother's heart works for two, while hormones during pregnancy also affect blood pressure and blood vessels, among other things. Sometimes a woman has to undergo surgery during pregnancy, for example because of a congenital heart defect or because of a spontaneous tear in the aorta (dissection) or infection of a heart valve (endocarditis). as these are intensive surgeries, many women need to be on the heart lung machine during the procedure. 

Fortunately, these situations rarely occur, but because of this, the scientific evidence for the best time to operate was lacking. 'Actually, in such a case you are dealing with two patients: the mother and the unborn baby,' explains Gijs van Steenbergen, first author of the study he conducted at the Cardiology and Cardiothoracic Surgery Departments of the Radboudumc. 'For both, it is very important to determine the best time for surgery. Now this was often done on the basis of experience or a single isolated case. We wanted better evidence for the best time to operate.'

A cesarean section prior to surgery

An analysis of the data of nearly 400 women from all available scientific studies followed. Van Steenbergen says, "We saw that women who underwent cesarean section prior to heart surgery had children who did better than children who were born after the operation. Even though some of these children are born earlier than the due date, they have a better outcome than babies who had to go through the heart surgery.'

The researchers, consisting of cardiac surgeons, cardiologists and gynecologists from the Radboudumc Amalia Children's Hospital, among others, concluded from this that it is preferable to postpone heart surgery until after delivery, if possible. 'We saw that in those cases where it is possible to wait, it makes little difference to the mother's health whether she undergoes a cesarean section or heart surgery first. But because it matters so much to the children, we concluded that a cesarean section prior to surgery is preferable,' said Van Steenbergen, now working at the Catharina Hospital in Eindhoven.

Improved registration

With his research, Van Steenbergen wants more attention for this group of patients. 'Fortunately we are learning more and more about female patients, and this research contributes to that. Now we want our conclusions to be adopted in international guidelines. This may take some time, but these results offer a lot of guidance.' So he is not finished yet, he continues. 'I now hope for better registration. Let's keep track of whether women with heart disease require surgery during pregnancy, and how they fare. In this way we will gain more knowledge and ultimately be able to help mother and child even better.'

Publication in European Heart Journal

Timing of cardiac surgery during pregnancy: a patient-level meta-analysis – Gijs J van Steenbergen, Queeny H Y Tsang, Olivier W H van der Heijden, Priya Vart, Laura Rodwell, Jolien W Roos-Hesselink, Roland R J van Kimmenade, Wilson W L Li, Ad F T M Verhagen. DOI: 10.1093/eurheartj/ehac234.

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