306: Pregnancy Following Aortic Valve Replacement - Cardiac, Maternal and Fetal Outcomes

Abstract

The choice of aortic valve substitute in young women should take the desire for pregnancy into account. Currently however, little is known about pregnancy-related outcomes following aortic valve replacement (AVR). The aim of this study was to assess cardiac, maternal and fetal-related outcomes in female patients with AVR during and after pregnancy. A retrospective study of all AVRs performed in women under the age of 40 years at our institution was undertaken. These patients were prospectively followed at our dedicated valve clinic. Patients with Turner syndrome or having undergone a hysterectomy and/or tubal ligation were excluded. Cardiovascular, maternal and fetal outcomes were gathered from medical records and telephone interviews. From 1976 to 2011, 77 women underwent 86 isolated AVRs: 65 mechanical prostheses (MPs) and 21 bioprostheses (BPs). The follow-up was 81% complete. Ten patients (13%) had 19 pregnancies at a mean age of 28±6 years. Of those, 5 ended in miscarriages (26%; n=4 BPs and n=1 MPs). Twelve (63%) pregnancies occurred in patients with BPs. The following adverse events were reported: two hospitalizations for syncope (25%), functional prosthetic valve deterioration during pregnancy necessitating reintervention 6 months post-partum (12%) and 4 miscarriages (33%). Nine of the 65 women (14%) with MPs had a hysterectomy or endometrial ablation for excessive uterine bleeding, precluding childbearing potential. In total, 7 pregnancies were reported in women with MPs. Two of them were terminated (n=1, medical advice and n=1 embolic myocardial infarction). The following peri-partum complications occurred: two embolic myocardial infarctions (33%), a postpartum bleeding (16%) and an urgent caesarean for placental abruption (16%). No fetal adverse events were observed. Findings from this study suggest that pregnancy in women with prosthetic AVR is associated with an increased risk of cardiac adverse outcomes.