Outcomes of Pregnancy in Women With Bioprosthetic Heart Valves With or Without Valve Dysfunction

Barbara Wichert-Schmitt, Jasmine Grewal, A Kinga Malinowski, Birgit Pfaller, Katie L Losenno, Marla C Kiess, Jack M Colman, Wendy Tsang, Jennifer Mason, Samuel C Siu, Candice K Silversides

Research output: Journal article (peer-reviewed)Journal article

1 Citation (Scopus)

Abstract

BACKGROUND: Although pregnancy outcomes in women with normally functioning bioprosthetic valves (BPVs) are often good, structural valve dysfunction (SVD) may adversely affect pregnancy outcomes, but this has not been studied.

OBJECTIVES: The aim of this study was to examine outcomes in pregnant women with BPVs and the association with SVD.

METHODS: Pregnancy outcomes in women with BPVs were prospectively collected. Adverse maternal cardiac events (CEs) included cardiac death or arrest, sustained arrhythmia, heart failure, thromboembolism, and stroke. Adverse fetal events were also studied. Determinants of adverse events were examined using logistic regression.

RESULTS: Overall, 125 pregnancies in women with BPVs were included, 27% with left-sided and 73% with right-sided BPV. SVD was present in 27% of the pregnancies (44% with left-sided BPVs vs 21% with right-sided BPVs; P = 0.009). CEs occurred in 13% of pregnancies and were more frequent in women with SVD compared with those with normally functioning BPVs (26% vs 8%; P = 0.005). CEs were more common in women with left-sided BPVs with SVD vs normally functioning BPVs (47% vs 5%; P = 0.01) but not in women with right-sided BPVs (11% in those with SVD vs 8% in those without SVD; P = 0.67). Left-sided SVD (P = 0.007), maternal age >35 years (P = 0.001), and a composite variable of "high-risk" features (P = 0.006) were predictors of CEs. Fetal events occurred in 28% of pregnancies.

CONCLUSIONS: In this cohort of young women with BPVs, SVD was present in 27% at the first antenatal visit and negatively affected pregnancy outcomes. In particular, SVD of left-sided BPVs was associated with high rates of adverse outcomes.

Original languageEnglish
Pages (from-to)2014-2024
Number of pages11
JournalJournal of the American College of Cardiology
Volume80
Issue number21
DOIs
Publication statusPublished - 22 Nov 2022

Keywords

  • Female
  • Pregnancy
  • Humans
  • Adult
  • Pregnancy Complications, Cardiovascular/epidemiology
  • Pregnancy Outcome/epidemiology
  • Heart Valve Prosthesis/adverse effects
  • Mitral Valve
  • Thromboembolism

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