Outcomes of Pregnancy After Right Ventricular Outflow Tract Reconstruction With an Allograft Conduit

Romeo, Jamie L R; Takkenberg, Johanna J.M.; Roos‐Hesselink, Jolien W.; Hanif, Milad; Cornette, Jérôme; Leeuwen, Wouter J. van; Dijk, Arie P.J. van; Bogers, Ad J.J.C.; Mokhles, M. Mostafa

doi:10.1016/j.jacc.2018.03.522

Cited by 11 publications

(23 citation statements)

References 38 publications

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“…Aortic valve homograft and pulmonary autograft are ideal options for young patients, women with childbearing potential or patients with contraindications to anticoagulation (5)(6)(7)(8)(9)(10)(11)15,16,19). Patient selection is crucial due to the caveat of increased early structural valve degeneration (SVD) (5,20,21).…”

Section: Introductionmentioning

confidence: 99%

Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis

Nappi¹,

Singh²,

Spadaccio³

et al. 2020

Ann Transl Med

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Aortic valve replacement is the most commonly performed cardiac surgical operation worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are the treatment goals. However, no detailed guidelines on prosthesis selection and surgical strategy are available.Management should be guided by a comprehensive evaluation of infection extension and its microbiological characteristics, the clinical profile of the patient and the risk of infection recurrence. We conducted a literature search of the PubMed database, EMBASE and Cochrane Library (through November 2019) for studies reporting to the use of biological substitutes in aortic valve endocarditis (AVE). Studies comparing long-term outcomes in the use of allogenic and autologous with conventional prostheses were investigated.Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. In cases of complex IE with the involvement of the root or the aorto-mitral continuity, the use of homografts are recommended, according to surgeon's and center experience. Homograft use needs to be balanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit with a mechanical or bioprosthetic valve are acceptable alternatives. The choice of aortic valves substitute and surgical strategy in IE is multifaceted. Principles guiding the selection of prosthesis and surgical approach rely on the longterm durability and the avoidance of infection relapse. A decisional algorithm considering the extension of the infection and its microbiological characteristics, the clinical profile of the patient and the risk of infection recurrence is provided. A multidisciplinary effort is required to achieve consistent outcomes.

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Section: Introductionmentioning

confidence: 99%

Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis

Nappi¹,

Singh²,

Spadaccio³

et al. 2020

Ann Transl Med

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“…After removing duplicates, 3963 records were screened, of which 131 were eligible for full‐text review. After review, the full texts of 33 articles were retained for the qualitative synthesis and quantitative analysis 41–73 . Upon request, one author sent additional data for their study 51 .…”

Section: Resultsmentioning

confidence: 99%

“…The 33 included studies were published between 1981 and 2018 and included 40 449 women with a diagnosis of CHD and 41 602 pregnancies 41–73 . Of these pregnancies, 718 (21 studies 41–45,47,50,52,54,57,59,61–65,67,70–73 ) ended before 20 weeks owing to spontaneous miscarriage and 183 (20 studies 41–45,47,50,52,54,57,59,61–65,67,70–72 ) owing to elective termination of pregnancy, leaving 40 701 pregnancies for analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Mean maternal age at inclusion was 28.3 ± 2.3 years, and mean gestational age at birth was 37.7 ± 1.57 weeks. There were 1747 (4.29%) cases of PE, eclampsia or HELLP syndrome among the 33 included studies 41–73 . Gestational hypertension occurred in 4.95% (169/3412; 13 studies 41–43,45,47,48,54,58,61,68,70–72 ) of pregnancies, maternal death in 0.15% (55/37 032; nine studies 41,46,49,58,60,62,66–68 ) and postnatal maternal cardiac complications in 1.78% (654/36 765; 12 studies 41,42,44–47,52,55,60,62,64,72 ).…”

Section: Resultsmentioning

confidence: 99%

“…Neonatal death occurred in 1.89% (102/5386; 19 studies 41,42,45,48,50,52,54,55,57,59,61–68,71 ) of pregnancies and preterm birth in 12.94% (620/4790; 24 studies 41,42,45–48, 50,52,54–59,61–65,67,68,70–72 ). Mean birth weight was 2739 ± 877 g according to 14 studies 41,42,44,48–50,53,54, 56,59,63,68,70,72 , and 12.01% of neonates were SGA/FGR (637/5306; 25 studies 41–43,45–50,53–59,62–67,70–72 ). Admission to the NICU was reported for 17.47% (29/166; two studies 46,65 ) of neonates and RDS was reported in 2.26% (39/1725; three studies 62,65,66 ).…”

Section: Resultsmentioning

confidence: 99%

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Incidence of pre‐eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta‐analysis

Martínez-Portilla

Poon

Benítez-Quintanilla

et al. 2021

Ultrasound in Obstet & Gyne

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Objective It has been proposed recently that pre‐eclampsia (PE) may originate from maternal cardiac maladaptation rather than primary placental insult. As congenital heart disease (CHD) is associated with reduced adaptation to the hemodynamic needs of pregnancy, it is hypothesized that women with CHD have an increased risk of PE. The aim of this systematic review was to investigate the risk of PE in pregnant women with CHD. Methods A systematic search was performed to identify relevant studies published in English, Spanish, French, Italian, Chinese or German, with no time restrictions, using databases such as PubMed, Web of Science and SCOPUS. Randomized controlled trials and observational studies (prospective or retrospective cohorts) of pregnant women with a history of CHD were sought. The main outcome was the incidence of PE (including eclampsia and HELLP syndrome). For quality assessment of the included studies, two reviewers assessed independently the risk of bias. For the meta‐analysis, the incidence of PE in pregnancies (those beyond 20 weeks' gestation) was calculated using single‐proportion analysis by random‐effects modeling (weighted by inverse variance). Heterogeneity between studies was assessed using the χ2 (Cochran's Q), tau2 and I2 statistics. Subgroup analysis was performed, and meta‐regression was used to assess the influence of several covariates on the pooled results. Results A total of 33 studies were included in the meta‐analysis, including 40 449 women with CHD and a total of 40 701 pregnancies. The weighted incidence of PE was 3.1% (95% CI, 2.2–4.0%), with true‐effect heterogeneity of 93% according to I2, and no publication bias found. No difference was found in the weighted incidence of PE between studies including cyanotic CHD vs those excluding (or not reporting) cyanotic CHD (2.5% (95% CI, 1.6–3.4%) vs 4.1% (95% CI, 2.4–5.7%); P = 0.0923). Meta‐regression analysis showed that the only cofactor that significantly influenced the incidence of PE in each study was the reported incidence of aortic stenosis; studies with a higher incidence of aortic stenosis had a higher incidence of PE (estimate: 0.0005; P = 0.038). Conclusions We failed to demonstrate an incidence of PE above the expected baseline risk in women with CHD. This observation contradicts the theory of the cardiac origin of PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

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Pregnancy in Tetralogy of Fallot data from the ESC EORP ROPAC registry

Baris

Ladouceur

Johnson

et al. 2021

International Journal of Cardiology Congenital Heart Disease

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Outcomes of Pregnancy After Right Ventricular Outflow Tract Reconstruction With an Allograft Conduit

Abstract: Women in good cardiac health after RVOT reconstruction with allografts can safely experience pregnancy and labor. The higher incidence of pre-term delivery and children small for gestational age warrants special attention.

Cited by 11 publications

References 38 publications

Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis

Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis

Incidence of pre‐eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta‐analysis

Pregnancy in Tetralogy of Fallot data from the ESC EORP ROPAC registry

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