Transcatheter Aortic Valve Replacement for Bioprosthetic Aortic Stenosis in Pregnancy

Management of aortic valve disease during pregnancy: A review

“…After multidisciplinary discussion with regional experts, she underwent successful valve‐in‐valve TAVI at 13 weeks gestation, allowing induced vaginal delivery at 39 weeks . Another case with a similar scenario has been reported very recently …”

Repeat Pregnancy after Prior Aortic Valve-in-Valve Replacement: A Cautionary Tale

“…4,5,[11][12][13] As of this writing, there have only been five reports of young women receiving TAVR or TAVR in SAVR while pregnant, one with severe native aortic valve stenosis and four with TAVR in SAVR. [6][7][8][9][10] It is unknown how women with a previous TAVR of severe aortic stenosis or TAVR in SAVR will tolerate subsequent pregnancies, due to lack of publications regarding short-and long-term maternal and fetal outcomes of repeat pregnancy after TAVR. Our case represents the first report of subsequent pregnancy outcome in a woman with prior TAVR in SAVR.…”

“…[17][18][19][20][21][22] In women with well-functioning biologic SAVR valves implanted prior to conception, it is rare for significant deterioration to occur during pregnancy, but this situation has been reported and may require intervention with TAVR in SAVR. 9,23 With TAVR in SAVR, two prosthetic biologic valves are now implanted, and there is evidence in the elderly that this biologic valve-in-valve combination may experience more rapid deterioration and/or valve leaflet thrombosis when compared A B Figure 4. Repeat gated computed tomography of the chest 1 day after delivery this current pregnancy.…”

“…Previously, individual case reports have described five women who received either TAVR for a severely stenotic aortic valve or TAVR in SAVR for symptomatic stenosis during pregnancy. [6][7][8][9][10] Following this procedure, all women had uncomplicated post-operative recovery, uneventful pregnancies, and successfully delivered healthy infants. However, outcomes of repeat pregnancy in women with prior TAVR or TAVR in SAVR are unreported at this time, and concerns have been raised regarding subsequent pregnancies in these women.…”

Management of Valvular Disease During Pregnancy: Evolving Role of Percutaneous Treatment

“…Therefore, despite the small amount of data during pregnancy, the valve-in-valve procedure already seems to be the optimal therapy for symptomatic pregnant women with severe bioprosthesis dysfunction in aortic and other anatomical locations. [31][32][33][34] However, there are no data regarding the safety and durability of such a procedure in young women. Moreover, due to the high prevalence of small aortic root anatomies in young women, the risk of prosthesis-patient mismatch in case of valve-in-valve implantation should be carefully evaluated.…”