Not Your Typical Dyspnea of Pregnancy: A Case Report of Transcatheter Valve-in-Valve Replacement During Pregnancy

Herbert, Katherine A.; Sheppard, Shaina M.

doi:10.1213/xaa.0000000000000884

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…Previously published literature on AVR during pregnancy was all in the pre-viable period, due to the inability to deliver even a pre-viable fetus in conjunction with the inability to further delay cardiac surgery based on maternal status ( Table 1 ). 5 , 6 , 7 , 8 , 9 However, preterm delivery even after viability may still carry significant neonatal morbidity and mortality and, if able to be avoided, is strongly preferred. Orwat et al 3 found that the peak aortic gradient before pregnancy as a continuous variable was the only independent predictor of complications.…”

Section: Question 4: At What Symptom or Mean Gradient Threshold Shoul...mentioning

confidence: 99%

TAVR Beyond Fetal Viability

Hoover,

Corlin,

Lohr

et al. 2023

JACC: Case Reports

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Section: Question 4: At What Symptom or Mean Gradient Threshold Shoul...mentioning

confidence: 99%

TAVR Beyond Fetal Viability

Hoover,

Corlin,

Lohr

et al. 2023

JACC: Case Reports

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“…Severe AS in pregnancy can cause various maternal and fetal disturbances because of the inability of the stenotic valve to support an adequate heart rate and stroke volume demand [14]. Most of the data on successful TAVI in pregnancy comes from case reports.…”

Section: Tavi In Pregnancymentioning

confidence: 99%

Aortic Stenosis Phenotypes and Precision Transcatheter Aortic Valve Implantation

Khawaja

Virk

Bandyopadhyay

et al. 2023

JCDD

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Patients with a clinical indication for aortic valve replacement can either undergo surgical aortic valve replacement (SAVR) or Transcatheter Aortic Valve Implantation (TAVI). There are many different factors that go into determining which type of replacement to undergo, including age, life expectancy, comorbidities, frailty, and patient preference. While both options offer significant benefits to patients in terms of clinical outcomes and quality of life, there is growing interest in expanding the indications for TAVI due to its minimally invasive approach. However, it is worth noting that there are several discrepancies in TAVI outcomes in regards to various endpoints, including death, stroke, and major cardiovascular events. It is unclear why these discrepancies exist, but potential explanations include the diversity of etiologies for aortic stenosis, complex patient comorbidities, and ongoing advancements in both medical therapies and devices. Of these possibilities, we propose that phenotypic variation of aortic stenosis has the most significant impact on post-TAVI clinical outcomes. Such variability in phenotypes is often due to a complex interplay between underlying comorbidities and environmental and inherent patient risk factors. However, there is growing evidence to suggest that patient genetics may also play a role in aortic stenosis pathology. As such, we propose that the selection and management of TAVI patients should emphasize a precision medicine approach.

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“…It is therefore essential to understand the potential advantages and limitations of this technology when performed during pregnancy. There are currently 7 reported cases of TAVR during pregnancy ( Table 2 ), 53 , 54 , 55 , 56 , 57 , 58 , 59 1 in a native bicuspid AV (BAV) and 6 in deteriorated bioprosthetic valves. The only case of TAVR in a native valve was reported by Hodson et al 53 in a 22-year-old female with the BAV, presenting at 15 weeks’ gestation with dizziness and dyspnea on exertion.…”

Section: Aortic Stenosismentioning

confidence: 99%