Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves

Abstract

Objectives Firstly, to compare pregnancy outcomes and cardiac complications in women with: 1. either mechanical or bioprosthetic valves at the mitral site; 2. mechanical valves treated with warfarin or subcutaneous heparin. Secondly, to determine pregnancy and cardiac outcomes in women with aortic homograft valves.Design Historical cohort study.Setting Greenlane Hospital, Auckland, New Zealand.Population Young women (n = 255) who had valve replacements between 1972 and 1992. Seventy-nine Main outcome measures Pregnancy loss, cardiac complications.Results Pregnancy loss occurred in 59% of pregnancies with mitral mechanical valves (n = 50) and 7%with mitral bioprosthetic valves (n = 33) (RR 8.20,95% CI 2.10-31.93). Pregnancy loss rate was 70%in pregnancies treated with warfarin, compared with 25% for those switched from warfarin to heparin (RR 2.81, 95% CI 1.03-7.73). All heparin-associated losses occurred in the first trimester, whereas there were four stillbirths with warfarin. Cardiac complications occurred in 10 pregnancies (20%) in the women with mitral mechanical valves and four (13%) with mitral bioprosthetic valves (RR 1.55, 95% CI 0.53452). All four thromboembolic complications with mechanical valves occurred in the 14 women treated with heparin throughout pregnancy. Structural valve deterioration occurred in four pregnancies (10%) with mitral bioprosthetic valves. No cardiac complications or known pregnancy losses occurred with aortic homograft valves (n = 41). ConclusionThe high pregnancy loss rate in women with mitral mechanical valves was associated with warfarin throughout pregnancy, whereas the thromboembolic cardiac complications were associated with heparin. Pregnancy outcome was very good in women with bioprosthetic and homograft valves.women underwent 147 pregnancies.

Atrial Fibrillation and Atrial Flutter in Pregnant Women—A Population‐Based Study

“…In the second and third trimesters, medications may have potential effects on fetal growth or lead to fetal arrhythmias 13. Many commonly used medications in AF, such as warfarin and some beta‐blockers, have been shown to increase the risks of adverse fetal outcomes 14, 15, 16, 17. Decisions regarding medication use are often difficult, given that though fetal exposure to a medication may pose risk, failure to treat AF could lead to significant hemodynamic compromise and, in turn, lead to poor fetal outcome.…”

Comparison between two different regimens of anticoagulants for pregnant women with prosthetic heart valves

“…These changes sideways with the presence of mechanical valves are associated with increased risks of thromboembolic risks. 7 Pregnancy in females with mechanical heart valves still a challenge to the obstetrician and the cardiologist. The main worry concerning the treatment during pregnancy is the teratogenic effect of the different anticoagulants on the fetus and the risk of thromboembolic complications for the mother.…”

“…Replacing OA with heparin decreases the risk of fetal damage, but increases the risk of valve thrombosis, even when given in adjusted doses. 6,7 The aim of the current study was to assess the maternal and fetal outcomes of pregnant females with prosthetic heart valves receiving oral anticoagulants only versus the sequential regimen of heparin and OA during the course of pregnancy.…”

Anticoagulación Y Embarazo

“…Los riesgos asociados a los anticoagulantes orales se presentan principalmente durante la segunda mitad del primer trimestre del embarazo (embriopatías) y periparto (hemorragias maternas y fetales). Dentro de los riesgos asociados se encuentran el aborto (11)(12)(13)(14)(15)18,19), la muerte fetal in útero (11,14,15,18), la embriopatía warfarínica (12-16) (con hipoplasia nasal y displasia punctuata de las epífisis de los huesos largos como hallazgos característicos), hemorragia intracraneal y secuelas neurológicas (20). El riesgo combinado de estas anomalías es de un 6,4% (14) y parece ser dosis dependiente (21).…”

“…En suma, las distintas alternativas de anticoagulación durante el embarazo ofrecen ciertas ventajas y desventajas respecto de las otras, siendo lo más significativo, que la heparina ofrece proteción al feto, pero aumenta el riesgo materno, mientras que los anticoagulantes orales protegen a la madre pero agravan el riesgo fetal (12).…”