Effects of Pregnancy on Long-Term Follow-Up of Mitral Valve Bioprostheses

Abstract

Between 1986 and 1990, 304 females between 11 and 45 (mean, 33.9 ± 6.9) years of age underwent isolated mitral valve replacement with a bioprosthesis. Thirty-nine of the 285 survivors experienced 48 pregnancies during the late follow-up period (group 1). Structural valve deterioration occurred in 25 (64.1%) of these patients and in 70 (28.4%) of the 246 patients (group 2) who did not become pregnant (p < 0.01). The mean time at which structural valve deterioration occurred was 7.01 ± 1.19 years postoperatively (range, 4.74 to 8.36 years) for group 1 patients and 6.76 ± 1.34 years (range, 2.33 to 10.17 years) for group 2 patients (p > 0.05).Freedom from structural valve deterioration at 10 years was 22.9% ± 8.11% for group 1 and 29.24% ± 6.09% for group 2 (p > 0.05). We concluded that pregnancy did not influence the long-term outcome after mitral valve replacement with a bioprosthesis.

Pregnancy outcomes in women with a mitral valve prosthesis: A systematic review and meta-analysis

“…In total, 16 studies were considered eligible for this meta-analysis, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 of which 1 study was included for subgroup analysis only because of overlapping population. 25 The individual study characteristics are listed in the Appendix E1 , Table E5 .

Figure 1 Flowchart of reference search, screening, and selection procedure.

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“…Six studies reported on pregnant women with bioprosthetic mitral valves, encompassing a total of 155 pregnancies. 10 , 11 , 12 , 17 , 20 , 25 In total, 23 women (14.8%) received prophylactic anticoagulant therapy due to chronic atrial fibrillation. A total of 14 studies reported on patients with mechanical prostheses, encompassing a total of 613 pregnancies.…”

“…Two studies reported long-term follow-up of patients who had bioprostheses in situ and conceived afterwards. 10 , 25 These 2 studies reported a pooled linearized SVD occurrence rate of 6.22%/patient-year (95% CI, 2.07-18.74) with a freedom from SVD at 8 years after implantation of 67.69%. In contrast, 4.71% (95% CI, 3.06-7.26) of the patients with a mechanical prosthesis developed valve thrombosis during pregnancy or within 30 days’ postpartum.…”

“…Two of the studies reported long-term durability outcomes of 87 pregnant women with a biological prosthesis in whom the occurrence of SVD was not proven to be accelerated when compared with nonpregnant patients. 10 , 25 In the case of acute SVD during pregnancy, transcatheter mitral valve-in-valve replacement may be an acceptable option that ensures protection of the fetus and shows promising results for the mother. 33 However, mid- and long-term durability is unknown, and the transcatheter procedure is accompanied with radiation, which may be teratogenous and should be taken into account.…”