Structural valve dysfunction ups risk of adverse outcomes in pregnant women with BPVs

Structural valve dysfunction (SVD) has occurred in nearly one in four young women with bioprosthetic heart valves (BPVs) at the first antenatal visit, and this may have harmful effects in pregnancy outcomes, reports a study. Specifically, SVD of left-sided BPVs is associated with high rates of adverse events (AEs).

To examine outcomes in pregnant women and the association with SVD, the investigators prospectively collected pregnancy outcomes in women with BPVs. Adverse maternal cardiac events (CEs) included cardiac death or arrest, sustained arrhythmia, heart failure, thromboembolism, and stroke. Adverse foetal events were also assessed. Logistic regression was used to examine determinants of AEs.

A total of 125 pregnancies in women with BPVs were examined, of which 27 had left-sided and 73 percent right-sided BPV. SVD was found in 27 percent of these pregnancies (44 percent with left-sided BPVs vs 21 percent with right-sided BPVs; p=0.009).

CEs occurred in 13 percent of pregnancies, more frequently so in women with SVD than those with normally functioning BPVs (26 percent vs 8 percent; p=0.005).

Notably, women with left-sided BPVs with SVD were more likely to experience CEs than those with normally functioning BPVs (47 percent vs 5 percent; p=0.01). CE rates were similar in women with right-sided BPVs (11 percent in those with SVD vs 8 percent in those without; p=0.67).

The following factors were significantly associated with CEs: left-sided SVD (p=0.007), maternal age <35 years (p=0.001), and a composite variable of “high-risk” feature (p=0.006).

Furthermore, foetal events happened in 28 percent of pregnancies.