TY - JOUR
T1 - Outcomes of Pregnancy in Women With Bioprosthetic Heart Valves With or Without Valve Dysfunction
AU - Wichert-Schmitt, Barbara
AU - Grewal, Jasmine
AU - Malinowski, A Kinga
AU - Pfaller, Birgit
AU - Losenno, Katie L
AU - Kiess, Marla C
AU - Colman, Jack M
AU - Tsang, Wendy
AU - Mason, Jennifer
AU - Siu, Samuel C
AU - Silversides, Candice K
N1 - Funding Information:
The authors gratefully acknowledge a generous donation provided by Mrs Josephine Rogers.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/11/22
Y1 - 2022/11/22
N2 - 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.
AB - 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.
KW - Female
KW - Pregnancy
KW - Humans
KW - Adult
KW - Pregnancy Complications, Cardiovascular/epidemiology
KW - Pregnancy Outcome/epidemiology
KW - Heart Valve Prosthesis/adverse effects
KW - Mitral Valve
KW - Thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85141335771&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2022.09.019
DO - 10.1016/j.jacc.2022.09.019
M3 - Journal article
C2 - 36396203
SN - 0735-1097
VL - 80
SP - 2014
EP - 2024
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -