Extracorporeal Membrane Oxygenation does not confer excess risk in Pregnancy

Sugrue, Ronan; Varvoutis, Megan; Wein, Lauren; Darwin, Kristin C.; Vaught, Arthur J.; Meng, Marie-Louise; Hughes, Brenna L.; Grotegut, Chad A.; Federspiel, Jerome J.

doi:10.1016/j.ajog.2021.11.148

Cited by 2 publications

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“…For those patients with significant hemodynamic compromise prompting consideration of extracorporeal membrane oxygenation, there has been recent limited evidence that it does not confer excess maternal risk in pregnancy. 5 While maternal outcomes from cardiac surgery are reportedly similar to non-pregnant female patients, current literature is limited to case series and retrospective reviews. The use of cardiopulmonary bypass and cardiac surgery in pregnancy is still controversial, and data on rates of surgical intervention are limited.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Shapero

Berlacher

Megli

2023

Preprint

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Background: The incidence of infective endocarditis (IE) in pregnancy is rare (0.006%) with increasing prevalence during the opioid epidemic. IE in pregnancy is associated with high rates of maternal and fetal mortality and morbidity, and existing data on outcomes in pregnancy is limited to case reports and small studies. Our study compares the outcomes of pregnant patients with IE as compared to non-pregnant patients. Methods: Patients diagnosed with IE during pregnancy or 30 days post-partum between 2014-2021 were identified by ICD-9/10 codes. Pregnant cases were matched to a random sampling of non-pregnant reproductive-age female endocarditis patients in a 1:4 ratio. Demographic and clinical data was collected. Data was validated through chart review. Results: 180 patients with IE were identified for this cohort; 34 were pregnant or within 30 days post-partum at diagnosis. There were higher rates of hepatitis C and opioid maintenance therapy in the pregnant patients. Etiology of IE in pregnant patients was predominantly S. aureus (MSSA/MRSA) whereas non-pregnant woman had greater microbiological variation. We observed comparable rates of valve replacement (32.4% vs 29% p=0.84), 2-yr mortality (20.6% vs 17.8%, p =.>0.99), and ICU admission (61.8% vs 69.8%, p=0.414) in pregnant patients. There was a trend towards higher rates of PE (17.6% vs 7.5%, p=0.098), arrhythmia (17.6% vs 9.6%, p=0.222) among pregnant patients. There were high rates of IVDU relapse in both groups (>40%). Conclusion: We observed similar rates of valve replacement, 2-year mortality, and ICU admission in both pregnant and non-pregnant patients with IE. We observed a microbial predilection for S.aureus in pregnancy suggesting that the physiology of pregnancy may select for this microbiologic etiology. These results represent the largest single center retrospective review of IE in pregnancy and suggests that pregnancy may have increased morbidity.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Shapero

Berlacher

Megli

2023

Preprint

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“…Recent studies demonstrate improving outcomes, likely due to early diagnosis and treatment, which range from medical management to surgical intervention depending on the severity of disease and infectious complications [ 1 , 3 ]. For those patients with significant hemodynamic compromise prompting consideration of extracorporeal membrane oxygenation (ECMO), there has been recent limited evidence that ECMO does not confer excess maternal risk in pregnancy [ 5 ]. While maternal outcomes from cardiac surgery are reportedly similar to those of nonpregnant female patients, the current literature is limited to case series and retrospective reviews.…”

mentioning

confidence: 99%

Outcomes of Endocarditis in Pregnancy: A Single-Center Experience

Shapero,

El-Dalati,

Berlacher

et al. 2023

Open Forum Infectious Diseases

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Background The incidence of infective endocarditis (IE) in pregnancy is rare (0.006%), with increasing prevalence during the opioid epidemic. IE in pregnancy is associated with high rates of mortality and morbidity, and existing data on outcomes in pregnancy are limited. Our study compares the outcomes of pregnant patients with IE with those of nonpregnant patients. Methods Patients diagnosed with IE during pregnancy and 30 days postpartum between 2014 and 2021 were identified by International Classification of Diseases, Clinical Modification, Ninth and Tenth Edition codes. Pregnant cases were matched to nonpregnant reproductive-age endocarditis patients in a 1:4 ratio. Data were collected and validated through chart review. Results One hundred eighty patients with IE were identified; 34 were pregnant or within 30 days postpartum at diagnosis. There were higher rates of hepatitis C and opioid maintenance therapy in the pregnant patients. The etiology of IE in pregnant patients was predominantly S. aureus (methicillin-resistant/sensitive S. aureus), whereas nonpregnant woman had greater microbiological variation. We observed comparable rates of valve replacement (32.4% vs 29%; P = .84) and 2-year mortality (20.6% vs 17.8%; P > .99) in pregnant patients. There were nonsignificantly higher rates of pulmonary emboli (17.6% vs 7.5%; P = .098) and arrhythmia (17.6% vs 9.6%; P = .222) among pregnant patients. There were high rates of intravenous drug use relapse in both groups (>40%). Conclusions We observed similar rates of mortality in the pregnant IE patients. We observed a microbial predilection for S. aureus in pregnancy, suggesting that the pregnancy physiology may select for this microbiologic etiology. This study, which represents the largest single-center retrospective review of IE in pregnancy, suggests that surgical intervention may be performed safely in the postpartum period.

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Extracorporeal Membrane Oxygenation does not confer excess risk in Pregnancy

Cited by 2 publications

References 0 publications

Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Outcomes of Endocarditis in Pregnancy: A Single Center Experience

Outcomes of Endocarditis in Pregnancy: A Single-Center Experience

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