Long-term evaluation of bovine pericardial bioprostheses in young women

Abstract

To avoid the fetal and maternal risks associated with anticoagulant therapy during pregnancy, the use of bioprostheses has been advocated for young women with cardiac valve disease during the childbearing years. Several reports have suggested the probability of pregnancy-related accelerated structural valve deterioration (SVD). The aim of this study was to assess the effect of pregnancy and delivery on bovine pericardial bioprostheses. Between 1986 and 2004, 13 female patients received 14 bioprostheses. The women were segregated into two groups based on whether pregnancy occurred during follow-up: eight in the Pregnant Group (Group P) (including one case who underwent two operations), and six in the Nonpregnant Group (Group NP). Early mortality was not observed. Late mortality was 12.5% for Group P and 16.7% for Group NP. There were a total of ten valve-related reoperations (seven in Group P and three in Group NP); the major reason was SVD in 64.3% of the cases. Freedom from valve-related reoperation at nine years was 28.6% in Group P and 33.3% in Group NP (p=0.338). Overall time from primary surgery to reoperation was 111 +/- 24.7 months, with no significant difference between the two groups (p=0.615). The Group P of eight patients had 12 pregnancies: ten deliveries and two abortions. There were no maternal or neonatal deaths. Pregnancy did not significantly influence the incidence of SVD and reoperation. The bioprostheses appears to provide female patients with more opportunity for uncomplicated pregnancies, deliveries and normal children than mechanical valves.