Biological versus mechanical heart valve prosthesis during pregnancy in women with congenital heart disease

Heleen Lameijer, Ymkje J. van Slooten, Monique R. M. Jongbloed, Martijn A. Oudijk, Marlies A. M. Kampman, Arie P. van Dijk, Marco C. Post, Barbara J. Mulder, Krystyna M. Sollie, Dirk J. van Veldhuisen, Tjark Ebels, Joost P. van Melle, Petronella G. Pieper

Research output: Contribution to journalArticle*Academicpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)106-112
JournalInternational Journal of Cardiology
Volume268
DOIs
Publication statusPublished - 2018

Cite this