PREGNANCY OUTCOME IN WOMEN WITH BIOPROSTHETIC HEART VALVES

Abstract

Background: 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 who may later wish to bear children. The aim of this historical cohort study was to evaluate pregnancy outcome in women with bioprosthetic heart valves.<br />Methods: Fifteen women who became pregnant after bioprosthetic heart valve replacement were followed during 28 pregnancies. Eleven had undergone isolated mitral, 3 had aortic and 1 had tricuspid valve replacement. Their ages at the time of surgery ranged from 14 to 31 years (mean 19.85±5.54).<br />All the women were in sinus rhythm at the time of gestation. No embolic episodes occurred either after surgery or during pregnancy, labor or the puerperium.<br />Results: Fetal loss occurred in 7 of the 28 pregnancies (25%), and was due to abortion (N=5), pre-maturity and neonatal death (N=2). No congenital malformation was seen. The mean birth weight in 21 pregnancies was 3082c, and only 1 newborn had low birth weight (2100gr). Two cases of rapid degeneration of bioprosthetic valves leading to reoperation occurred in two patients, one in the 7th month of pregnancy and the other 4 months after delivery.<br />Conclusion: Bioprosthetic valves can be considered the most suitable prosthetic heart valve employed in women of childbearing age because anticoagulants can be avoided, so the risk of embryopathy following the use of anticoagulant drugs is omitted.