Abstract 14993: Does Pregnancy Increase the Risk of Deterioration of Homograft Valves? A Systematic Review and Meta-analysis

Abstract

Introduction: A previous meta-analysis found that pregnancy increases the risk of structural valve deterioration (SVD) of bioprosthetic valves. However both homografts and xenografts were included indistinctly in the analysis. The purpose of this study is to conduct a meta-analysis to determine if pregnancy independently increases the risk of SVD in women recipient of homograft and xenograft valves. Methods: We searched MEDLINE, EMBASE, CINAHL, Web of Knowledge, and Cochrane Library databases for articles published from inception until May 2015. Only cohort and case control studies were included. We calculated the relative risk (RR) and the corresponding 95% confidence interval (CI) of having SVD by pregnancy status using the DeSirmonian-Laird method. Meta-regression examined the RR of SVD by age, number of pregnancies and time from valve replacement to delivery. Results: Our search strategy yielded 23 publications; nine studies met inclusion criteria. Two studies (75 women) were performed in recipients of homografts. They were divided in two groups according to their history of pregnancies, 22 who were pregnant at least once and 53 who never were pregnant. Eight studies (1071 women) assessed SVD in women recipient of xenografts, including 282 women who had been pregnant and 789 who never were pregnant. Twenty (26.6%) and 341 (31.8%) women recipients of homografts and xenografts respectively developed SVD. Among the recipients of xenografts, the RR of having SVD in pregnant women was 1.70; 95% CI 1.26-2.29; p<0.01 (Figure), whereas it was 1.03 (95% CI 0.45-2.33; p<0.01) in recipients of homografts. None of the factors evaluated in meta-regression in recipients of xenografts were statistically significant. Conclusion: Pregnancy does increase the risk of SVD in recipients of xenografts, but no homografts. Homografts would be a better option than xenografts in women of childbearing age non suitable for long-term anticoagulation.