Results:

1. A total of 8 patients underwent cardiac surgical interventions during pregnancy or the postpartum period. The mean age was approximately 32 years (range: 26-38 years).
2. Most patients presented during pregnancy (n=5), at gestational ages ranging from 14 to 28 weeks, while 3 patients were operated in the postpartum period (ranging from 6 days to 2 weeks post-delivery). One patient had an intrauterine device in situ, and one case involved a twin pregnancy.
3. Mitral Valve Replacement (MVR) was the most commonly performed procedure (n=4 isolated MVR), while combined procedures included AVR+MVR (n=1), DVR (n=1), VSD closure+AVR (n=1), and aortic root replacement (n=1). The majority of valves used were bioprosthetic (tissue valves), with one case requiring a mechanical valve.
4. The mean Cardiopulmonary Bypass (CPB) time ranged from 100 to 235 minutes, and crossclamp time ranged from 65 to 180 minutes. Minimum intraoperative temperatures varied between 28.3 °C and 35 °C, reflecting tailored hypothermia strategies.
5. Despite the complexity of cases, including redo surgery and combined procedures, surgical interventions were successfully performed across all patients

Conclusion: Cardiac surgery during or soon after pregnancy can be successfully performed in LMICs through a structured multidisciplinary approach and adherence to evidence-based perioperative principles. This series highlights that high-quality care for critically ill pregnant cardiac patients is not only possible in resource-limited environments, but achievable to a standard of excellence.

Keywords: Pregnancy; Cardiac surgery; Valve replacement; Cardiopulmonary bypass; Maternal Outcomes; LMIC; Multidisciplinary Care