TY - JOUR
T1 - Biological versus mechanical heart valve prosthesis during pregnancy in women with congenital heart disease
AU - Lameijer, Heleen
AU - van Slooten, Ymkje J.
AU - Jongbloed, Monique R. M.
AU - Oudijk, Martijn A.
AU - Kampman, Marlies A. M.
AU - van Dijk, Arie P.
AU - Post, Marco C.
AU - Mulder, Barbara J.
AU - Sollie, Krystyna M.
AU - van Veldhuisen, Dirk J.
AU - Ebels, Tjark
AU - van Melle, Joost P.
AU - Pieper, Petronella G.
PY - 2018
Y1 - 2018
N2 - Background: We evaluate pregnancy outcome and anticoagulation regimes in women with mechanical and biological prosthetic heart valves (PHV) for congenital heart disease. Methods: Retrospective multicenter cohort studying pregnancy outcomes in an existing cohort of patients with PHV. Results: 52 women had 102 pregnancies of which 78 pregnancies (46 women) ≥20 weeks duration (59 biological, 19 mechanical PHV). Miscarriages (n = 19, ≤20 weeks) occurred more frequently in women using anticoagulation (P <.05). During 42% of pregnancies of women with mechanical PHV a combined low molecular weight heparin (LMWH) vitamin-K-antagonist anticoagulation regime was used (n = 8). Overall, cardiovascular, obstetric and fetal/neonatal complications occurred in 17% (n = 13), 68% (n = 42) and 42% (n = 27) of the pregnancies. Women with mechanical PHV had significantly higher cardiovascular (12% vs 32%, P <.05), obstetric (59% vs 85%, P =.02) and fetal/neonatal (34% vs 61%, P <.05) complication rates than women with biological PHV. This was related to PHV thrombosis (n = 3, P <.02), post-partum hemorrhage (P <.02), cesarean section (P <.02), low birth weight and small for gestational age (both P <.05). PHV thrombosis occurred in 3 pregnancies, including 2/5 pregnancies with pulmonary mechanical PHV. PHV thrombosis was related to necessary cessation of anticoagulation therapy or insufficient monitoring of LMWH. Other cardiovascular complications occurred equally frequent in both groups. Conclusion: Complications occur more often in pregnancies of women with a mechanical PHV than in women with a biological PHV, mainly caused by PHV thrombosis and bleeding complications. Meticulous monitoring of anticoagulation in pregnant women is necessary. Women with a pulmonary mechanical PHV are at high risk of complications.
AB - Background: We evaluate pregnancy outcome and anticoagulation regimes in women with mechanical and biological prosthetic heart valves (PHV) for congenital heart disease. Methods: Retrospective multicenter cohort studying pregnancy outcomes in an existing cohort of patients with PHV. Results: 52 women had 102 pregnancies of which 78 pregnancies (46 women) ≥20 weeks duration (59 biological, 19 mechanical PHV). Miscarriages (n = 19, ≤20 weeks) occurred more frequently in women using anticoagulation (P <.05). During 42% of pregnancies of women with mechanical PHV a combined low molecular weight heparin (LMWH) vitamin-K-antagonist anticoagulation regime was used (n = 8). Overall, cardiovascular, obstetric and fetal/neonatal complications occurred in 17% (n = 13), 68% (n = 42) and 42% (n = 27) of the pregnancies. Women with mechanical PHV had significantly higher cardiovascular (12% vs 32%, P <.05), obstetric (59% vs 85%, P =.02) and fetal/neonatal (34% vs 61%, P <.05) complication rates than women with biological PHV. This was related to PHV thrombosis (n = 3, P <.02), post-partum hemorrhage (P <.02), cesarean section (P <.02), low birth weight and small for gestational age (both P <.05). PHV thrombosis occurred in 3 pregnancies, including 2/5 pregnancies with pulmonary mechanical PHV. PHV thrombosis was related to necessary cessation of anticoagulation therapy or insufficient monitoring of LMWH. Other cardiovascular complications occurred equally frequent in both groups. Conclusion: Complications occur more often in pregnancies of women with a mechanical PHV than in women with a biological PHV, mainly caused by PHV thrombosis and bleeding complications. Meticulous monitoring of anticoagulation in pregnant women is necessary. Women with a pulmonary mechanical PHV are at high risk of complications.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85047399110&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29848449
U2 - https://doi.org/10.1016/j.ijcard.2018.05.038
DO - https://doi.org/10.1016/j.ijcard.2018.05.038
M3 - Article
C2 - 29848449
SN - 0167-5273
VL - 268
SP - 106
EP - 112
JO - International journal of cardiology
JF - International journal of cardiology
ER -