Abstract 17037: Effect of Pregnancy on Long-Term Prosthetic Cardiac Valve Survival

Abstract

Introduction: The effect of pregnancy on the lifespan of prosthetic heart valves is an important consideration in valve selection for women with valvular heart disease who may desire future pregnancy. Current evidence is mixed and limited to small, single-center studies. Methods: Retrospective analysis of 11,930 women ≤50 years of age who underwent 14,017 valve replacements in California, New Jersey, and New York State between 1990 and 2015. Patient were identified using state-run mandatory administrative databases. Average follow-up time was 9.4 years (SD 6.7 years). To evaluate the association between pregnancy and time to reoperation, time-dependent propensity scoring was used to match women with pregnancy at the time of earliest delivery with controls at risk for pregnancy within the same year after valve implantation. Controls were any woman with valve implantation and without exposure to pregnancy during the study period that was free from reoperation, death, or censoring at the time of matching. Results: Pregnancies in 417 women with 241 biologic valves and 217 mechanical valves were identified. After propensity score matching, there were no significant differences between the pregnant and control groups for both the cohorts with biologic and mechanical valves. Pregnancy was a significant risk factor for reoperation for both biologic (HR 2.5, 95% CI 1.6-3.8 after time-dependent propensity matching) and mechanical (HR 2.3, 95% CI 1.3-4.1 after time-dependent propensity matching) prostheses. For women with mechanical valves who experienced pregnancy and subsequently required reoperation, almost half of reoperations occurred within one year of delivery. Almost all were performed on valves at the mitral position (84.6%) and had diagnosis codes for valve-related complications, including valve thrombosis (76.9%). Conclusion: Pregnancy accelerates time to reoperation for both biologic and mechanical prostheses. Mechanical valves, especially those in the mitral position, are at particular risk for near-term valve loss after delivery.