Pregnancy in Women with a Mechanical Heart Valve

Iris M. Van Hagen; Jolien W. Roos-Hesselink; Titia P.E. Ruys; Waltraut M. Merz; Sorel Goland; Harald Gabriel; Malgorzata Lelonek; Olga Trojnarska; Wael Abdulrahman Al Mahmeed; Hajnalka Olga Balint; Zeinab Ashour; Helmut Baumgartner; Eric Boersma; Mark R. Johnson; Roger Hall; Roberto Ferrari; Aldo P. Maggioni; Ariane Marelli; Gary Webb; Harald Kaemmerer; Jana Popelova; Karen Sliwa; Luigi Tavazzi; William Anthony Parsonage; Joerg Stein; Uri Elkayam; Ulf Thilen; Werner Budts; Panos Vardas; Michel Komajda; Fausto Pinto; Angeles Alonso; David Wood; Nikolaos Maniadakis; Thierry Ferreira; Gérard Gracia; Cécile Laroche; Viviane Missiamenou; Charles Taylor; Marème Konte; Maryna Andarala; Emanuela Fiorucci; Elin Folkesson Lefrancq; Myriam Glémot; Patti Ann McNeill; Caroline Pommier; Myriam Lafay; A. Aquieri; H. Ruda Vega; M. Vázquez Blanco; K. Lust; N. Fagermo; E. Donhauser; Z. Gasimov; T. Jahangirov; I. Hasanova; J. De Backer; L. Demulier; M. de Hosson; M. Beckx; M. Moissens; T. Kovacevic-Preradovic; M. Kozic; M. Lovric; C. Vilas Freire; N. Chilingirova; P. Kratunkov; A. R. Montesclaros; E. Beaubien; E. Gordon; L. Walter; C. Lindsay; N. Wahab; Z. Vavera; A. E. El Nagar; H. H. Ebaid; W. A. El Sayed Makled; N. Taha; A. Dardier; M. Shabaan; Y. Elrakshy; K. Eltamawey; M. Gamal Abd-El Aziz; A. Saad; W. Aboleineen; K. Sorour; M. A.Meguid Mahdy; L. Iserin; M. Ladouceur; S. Cohen; B. Iung; D. Maisuradze; S. Mebus; U. Gembruch; C. Hammerstingl; C. Wald; S. Orwat; R. Schmidt; R. Motz; A. Olsson; F. Berger; N. Nagdyman; A. Frogoudaki; M. Anastasiou-Nana; A. Temesvari; D. Kohalmi; B. Merkely; C. Liptai; M. Bowen; M. Cullen; P. Thornton; V. Husarova; A. Blatt; G. Elbaz-Greener; G. Moravsky; Z. Vered; A. Vazan Fuhrmann; A. Shotan; P. Festa; L. Ait Ali; G. Sinagra; I. Puggia; B. D.Agata Mottolese; M. G. Carmina; C. Romeo; R. Crepaz; V. Fesslova; A. Azzarelli; D. Baldi; F. Bovenzi; V. Donvito; E. Vasario; T. Todros; K. Niwa; A. Mussagaliyeva; D. Mekebekova; S. Sharipova; R. Zaliunas; R. Jonkaitiene; J. Petrauskaite; L. Gumbiene; S. Jovanova; A. Cassar; M. Caruana; Y. Karamermer; J. M.J. Cornette; A. van Dijk; L. Bellersen; T. Duijnhouwer; C. De Groot; E. P.G. Pieper; C. van Oppen; P. Polak; E. Wajon; L. Wagenaar; M. Estensen; A. Lesniak-Sobelga; P. Podolec; S. Wisniowska-Smialek; A. Trybuch; P. Hoffman; A. Cichocka-Radwan; S. Sobczak; U. Faflik; A. Tomaszuk-Kazberuk; J. Przepiesc; M. Gil; K. Plaskota; N. Guerra; L. de Sousa; V. Petrescu; C. Ginghina; R. Jurcut; I. Mircea Coman; I. Ravilevich Gaisin; L. Valeryevna Shilina; N. Sharashkina; O. Tkacheva; D. Ivanov; O. Irtyuga; L. Jovovic; K. Prokselj; M. Kozelj; C. Elliott; L. Galian-Gay; A. Pijuan-Domenech; M. T. Subirana-Domenech; P. Tornos; N. Murga; J. M. Oliver; P. Escribano-Subías; M. J. Ruiz-Cano; J. Delgado-Jiménez; E. Furenas; M. Dellborg; U. Thilén; M. Schwerzmann; J. Bouchardy; T. Rutz; D. Tobler; L. Sarac; O. B. Esen; S. C. Enar; A. Al Mulla; N. Bazargani; E. Al Hatou; F. Farook; B. Salih; P. Clifford; N. Bowers; G. Veldtman; J. Kerr; L. Tellett; L. Hudsmith; P. Thompson; S. Thorne; S. Bowater; P. Nihoyannopoulos; R. Curry; L. Freeman; F. Schroeder; R. Wendler; S. Hammond; C. Talluto; D. Murphy; M. G. Perlroth; K. Chintala; P. Gupta; E. Pare; N. Khatri; N. Scott; D. De Faria-Yeh; A. B. Bhatt; S. Tsiaras; M. Gurvitz; C. Otto; J. Botti; J. Ting; W. R. Davidson

doi:10.1161/CIRCULATIONAHA.115.015242

Pregnancy in Women with a Mechanical Heart Valve

Iris M. Van Hagen, Jolien W. Roos-Hesselink, Titia P.E. Ruys, Waltraut M. Merz, Sorel Goland, Harald Gabriel, Malgorzata Lelonek, Olga Trojnarska, Wael Abdulrahman Al Mahmeed, Hajnalka Olga Balint, Zeinab Ashour, Helmut Baumgartner, Eric Boersma, Mark R. Johnson, Roger Hall, Roberto Ferrari, Aldo P. Maggioni, Ariane Marelli, Gary Webb, Harald KaemmererJana Popelova, Karen Sliwa, Luigi Tavazzi, William Anthony Parsonage, Joerg Stein, Uri Elkayam, Ulf Thilen, Werner Budts, Panos Vardas, Michel Komajda, Fausto Pinto, Angeles Alonso, David Wood, Nikolaos Maniadakis, Thierry Ferreira, Gérard Gracia, Cécile Laroche, Viviane Missiamenou, Charles Taylor, Marème Konte, Maryna Andarala, Emanuela Fiorucci, Elin Folkesson Lefrancq, Myriam Glémot, Patti Ann McNeill, Caroline Pommier, Myriam Lafay, A. Aquieri, H. Ruda Vega, M. Vázquez Blanco, K. Lust, N. Fagermo, E. Donhauser, Z. Gasimov, T. Jahangirov, I. Hasanova, J. De Backer, L. Demulier, M. de Hosson, M. Beckx, M. Moissens, T. Kovacevic-Preradovic, M. Kozic, M. Lovric, C. Vilas Freire, N. Chilingirova, P. Kratunkov, A. R. Montesclaros, E. Beaubien, E. Gordon, L. Walter, C. Lindsay, N. Wahab, Z. Vavera, A. E. El Nagar, H. H. Ebaid, W. A. El Sayed Makled, N. Taha, A. Dardier, M. Shabaan, Y. Elrakshy, K. Eltamawey, M. Gamal Abd-El Aziz, A. Saad, W. Aboleineen, K. Sorour, M. A.Meguid Mahdy, L. Iserin, M. Ladouceur, S. Cohen, B. Iung, D. Maisuradze, S. Mebus, U. Gembruch, C. Hammerstingl, C. Wald, S. Orwat, R. Schmidt, R. Motz, A. Olsson, F. Berger, N. Nagdyman, A. Frogoudaki, M. Anastasiou-Nana, A. Temesvari, D. Kohalmi, B. Merkely, C. Liptai, M. Bowen, M. Cullen, P. Thornton, V. Husarova, A. Blatt, G. Elbaz-Greener, G. Moravsky, Z. Vered, A. Vazan Fuhrmann, A. Shotan, P. Festa, L. Ait Ali, G. Sinagra, I. Puggia, B. D.Agata Mottolese, M. G. Carmina, C. Romeo, R. Crepaz, V. Fesslova, A. Azzarelli, D. Baldi, F. Bovenzi, V. Donvito, E. Vasario, T. Todros, K. Niwa, A. Mussagaliyeva, D. Mekebekova, S. Sharipova, R. Zaliunas, R. Jonkaitiene, J. Petrauskaite, L. Gumbiene, S. Jovanova, A. Cassar, M. Caruana, Y. Karamermer, J. M.J. Cornette, A. van Dijk, L. Bellersen, T. Duijnhouwer, C. De Groot, E. P.G. Pieper, C. van Oppen, P. Polak, E. Wajon, L. Wagenaar, M. Estensen, A. Lesniak-Sobelga, P. Podolec, S. Wisniowska-Smialek, A. Trybuch, P. Hoffman, A. Cichocka-Radwan, S. Sobczak, U. Faflik, A. Tomaszuk-Kazberuk, J. Przepiesc, M. Gil, K. Plaskota, N. Guerra, L. de Sousa, V. Petrescu, C. Ginghina, R. Jurcut, I. Mircea Coman, I. Ravilevich Gaisin, L. Valeryevna Shilina, N. Sharashkina, O. Tkacheva, D. Ivanov, O. Irtyuga, L. Jovovic, K. Prokselj, M. Kozelj, C. Elliott, L. Galian-Gay, A. Pijuan-Domenech, M. T. Subirana-Domenech, P. Tornos, N. Murga, J. M. Oliver, P. Escribano-Subías, M. J. Ruiz-Cano, J. Delgado-Jiménez, E. Furenas, M. Dellborg, U. Thilén, M. Schwerzmann, J. Bouchardy, T. Rutz, D. Tobler, L. Sarac, O. B. Esen, S. C. Enar, A. Al Mulla, N. Bazargani, E. Al Hatou, F. Farook, B. Salih, P. Clifford, N. Bowers, G. Veldtman, J. Kerr, L. Tellett, L. Hudsmith, P. Thompson, S. Thorne, S. Bowater, P. Nihoyannopoulos, R. Curry, L. Freeman, F. Schroeder, R. Wendler, S. Hammond, C. Talluto, D. Murphy, M. G. Perlroth, K. Chintala, P. Gupta, E. Pare, N. Khatri, N. Scott, D. De Faria-Yeh, A. B. Bhatt, S. Tsiaras, M. Gurvitz, C. Otto, J. Botti, J. Ting, W. R. Davidson

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

244 Scopus citations

Abstract

Background - Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results - Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). Conclusions - Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive prepregnancy counseling and centralization of care.

Original language	English (US)
Pages (from-to)	132-142
Number of pages	11
Journal	Circulation
Volume	132
Issue number	2
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.115.015242
State	Published - Jul 14 2015

Keywords

heart defects congenital
heart valves
pregnancy
prostheses and implants
thrombosis

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

Access to Document

10.1161/CIRCULATIONAHA.115.015242

Cite this

Van Hagen, I. M., Roos-Hesselink, J. W., Ruys, T. P. E., Merz, W. M., Goland, S., Gabriel, H., Lelonek, M., Trojnarska, O., Al Mahmeed, W. A., Balint, H. O., Ashour, Z., Baumgartner, H., Boersma, E., Johnson, M. R., Hall, R., Ferrari, R., Maggioni, A. P., Marelli, A., Webb, G., ... Davidson, W. R. (2015). Pregnancy in Women with a Mechanical Heart Valve. Circulation, 132(2), 132-142. https://doi.org/10.1161/CIRCULATIONAHA.115.015242

Van Hagen, IM, Roos-Hesselink, JW, Ruys, TPE, Merz, WM, Goland, S, Gabriel, H, Lelonek, M, Trojnarska, O, Al Mahmeed, WA, Balint, HO, Ashour, Z, Baumgartner, H, Boersma, E, Johnson, MR, Hall, R, Ferrari, R, Maggioni, AP, Marelli, A, Webb, G, Kaemmerer, H, Popelova, J, Sliwa, K, Tavazzi, L, Parsonage, WA, Stein, J, Elkayam, U, Thilen, U, Budts, W, Vardas, P, Komajda, M, Pinto, F, Alonso, A, Wood, D, Maniadakis, N, Ferreira, T, Gracia, G, Laroche, C, Missiamenou, V, Taylor, C, Konte, M, Andarala, M, Fiorucci, E, Lefrancq, EF, Glémot, M, McNeill, PA, Pommier, C, Lafay, M, Aquieri, A, Vega, HR, Blanco, MV, Lust, K, Fagermo, N, Donhauser, E, Gasimov, Z, Jahangirov, T, Hasanova, I, De Backer, J, Demulier, L, de Hosson, M, Beckx, M, Moissens, M, Kovacevic-Preradovic, T, Kozic, M, Lovric, M, Freire, CV, Chilingirova, N, Kratunkov, P, Montesclaros, AR, Beaubien, E, Gordon, E, Walter, L, Lindsay, C, Wahab, N, Vavera, Z, El Nagar, AE, Ebaid, HH, El Sayed Makled, WA, Taha, N, Dardier, A, Shabaan, M, Elrakshy, Y, Eltamawey, K, Abd-El Aziz, MG, Saad, A, Aboleineen, W, Sorour, K, Mahdy, MAM, Iserin, L, Ladouceur, M, Cohen, S, Iung, B, Maisuradze, D, Mebus, S, Gembruch, U, Hammerstingl, C, Wald, C, Orwat, S, Schmidt, R, Motz, R, Olsson, A, Berger, F, Nagdyman, N, Frogoudaki, A, Anastasiou-Nana, M, Temesvari, A, Kohalmi, D, Merkely, B, Liptai, C, Bowen, M, Cullen, M, Thornton, P, Husarova, V, Blatt, A, Elbaz-Greener, G, Moravsky, G, Vered, Z, Fuhrmann, AV, Shotan, A, Festa, P, Ali, LA, Sinagra, G, Puggia, I, Mottolese, BDA, Carmina, MG, Romeo, C, Crepaz, R, Fesslova, V, Azzarelli, A, Baldi, D, Bovenzi, F, Donvito, V, Vasario, E, Todros, T, Niwa, K, Mussagaliyeva, A, Mekebekova, D, Sharipova, S, Zaliunas, R, Jonkaitiene, R, Petrauskaite, J, Gumbiene, L, Jovanova, S, Cassar, A, Caruana, M, Karamermer, Y, Cornette, JMJ, van Dijk, A, Bellersen, L, Duijnhouwer, T, De Groot, C, Pieper, EPG, van Oppen, C, Polak, P, Wajon, E, Wagenaar, L, Estensen, M, Lesniak-Sobelga, A, Podolec, P, Wisniowska-Smialek, S, Trybuch, A, Hoffman, P, Cichocka-Radwan, A, Sobczak, S, Faflik, U, Tomaszuk-Kazberuk, A, Przepiesc, J, Gil, M, Plaskota, K, Guerra, N, de Sousa, L, Petrescu, V, Ginghina, C, Jurcut, R, Coman, IM, Gaisin, IR, Shilina, LV, Sharashkina, N, Tkacheva, O, Ivanov, D, Irtyuga, O, Jovovic, L, Prokselj, K, Kozelj, M, Elliott, C, Galian-Gay, L, Pijuan-Domenech, A, Subirana-Domenech, MT, Tornos, P, Murga, N, Oliver, JM, Escribano-Subías, P, Ruiz-Cano, MJ, Delgado-Jiménez, J, Furenas, E, Dellborg, M, Thilén, U, Schwerzmann, M, Bouchardy, J, Rutz, T, Tobler, D, Sarac, L, Esen, OB, Enar, SC, Al Mulla, A, Bazargani, N, Al Hatou, E, Farook, F, Salih, B, Clifford, P, Bowers, N, Veldtman, G, Kerr, J, Tellett, L, Hudsmith, L, Thompson, P, Thorne, S, Bowater, S, Nihoyannopoulos, P, Curry, R, Freeman, L, Schroeder, F, Wendler, R, Hammond, S, Talluto, C, Murphy, D, Perlroth, MG, Chintala, K, Gupta, P, Pare, E, Khatri, N, Scott, N, De Faria-Yeh, D, Bhatt, AB, Tsiaras, S, Gurvitz, M, Otto, C, Botti, J, Ting, J & Davidson, WR 2015, 'Pregnancy in Women with a Mechanical Heart Valve', Circulation, vol. 132, no. 2, pp. 132-142. https://doi.org/10.1161/CIRCULATIONAHA.115.015242

@article{027b2105b67a4de4924750c95955b906,

title = "Pregnancy in Women with a Mechanical Heart Valve",

abstract = "Background - Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results - Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). Conclusions - Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive prepregnancy counseling and centralization of care.",

keywords = "heart defects congenital, heart valves, pregnancy, prostheses and implants, thrombosis",

author = "{Van Hagen}, {Iris M.} and Roos-Hesselink, {Jolien W.} and Ruys, {Titia P.E.} and Merz, {Waltraut M.} and Sorel Goland and Harald Gabriel and Malgorzata Lelonek and Olga Trojnarska and {Al Mahmeed}, {Wael Abdulrahman} and Balint, {Hajnalka Olga} and Zeinab Ashour and Helmut Baumgartner and Eric Boersma and Johnson, {Mark R.} and Roger Hall and Roberto Ferrari and Maggioni, {Aldo P.} and Ariane Marelli and Gary Webb and Harald Kaemmerer and Jana Popelova and Karen Sliwa and Luigi Tavazzi and Parsonage, {William Anthony} and Joerg Stein and Uri Elkayam and Ulf Thilen and Werner Budts and Panos Vardas and Michel Komajda and Fausto Pinto and Angeles Alonso and David Wood and Nikolaos Maniadakis and Thierry Ferreira and G{\'e}rard Gracia and C{\'e}cile Laroche and Viviane Missiamenou and Charles Taylor and Mar{\`e}me Konte and Maryna Andarala and Emanuela Fiorucci and Lefrancq, {Elin Folkesson} and Myriam Gl{\'e}mot and McNeill, {Patti Ann} and Caroline Pommier and Myriam Lafay and A. Aquieri and Vega, {H. Ruda} and Blanco, {M. V{\'a}zquez} and K. Lust and N. Fagermo and E. Donhauser and Z. Gasimov and T. Jahangirov and I. Hasanova and {De Backer}, J. and L. Demulier and {de Hosson}, M. and M. Beckx and M. Moissens and T. Kovacevic-Preradovic and M. Kozic and M. Lovric and Freire, {C. Vilas} and N. Chilingirova and P. Kratunkov and Montesclaros, {A. R.} and E. Beaubien and E. Gordon and L. Walter and C. Lindsay and N. Wahab and Z. Vavera and {El Nagar}, {A. E.} and Ebaid, {H. H.} and {El Sayed Makled}, {W. A.} and N. Taha and A. Dardier and M. Shabaan and Y. Elrakshy and K. Eltamawey and {Abd-El Aziz}, {M. Gamal} and A. Saad and W. Aboleineen and K. Sorour and Mahdy, {M. A.Meguid} and L. Iserin and M. Ladouceur and S. Cohen and B. Iung and D. Maisuradze and S. Mebus and U. Gembruch and C. Hammerstingl and C. Wald and S. Orwat and R. Schmidt and R. Motz and A. Olsson and F. Berger and N. Nagdyman and A. Frogoudaki and M. Anastasiou-Nana and A. Temesvari and D. Kohalmi and B. Merkely and C. Liptai and M. Bowen and M. Cullen and P. Thornton and V. Husarova and A. Blatt and G. Elbaz-Greener and G. Moravsky and Z. Vered and Fuhrmann, {A. Vazan} and A. Shotan and P. Festa and Ali, {L. Ait} and G. Sinagra and I. Puggia and Mottolese, {B. D.Agata} and Carmina, {M. G.} and C. Romeo and R. Crepaz and V. Fesslova and A. Azzarelli and D. Baldi and F. Bovenzi and V. Donvito and E. Vasario and T. Todros and K. Niwa and A. Mussagaliyeva and D. Mekebekova and S. Sharipova and R. Zaliunas and R. Jonkaitiene and J. Petrauskaite and L. Gumbiene and S. Jovanova and A. Cassar and M. Caruana and Y. Karamermer and Cornette, {J. M.J.} and {van Dijk}, A. and L. Bellersen and T. Duijnhouwer and {De Groot}, C. and Pieper, {E. P.G.} and {van Oppen}, C. and P. Polak and E. Wajon and L. Wagenaar and M. Estensen and A. Lesniak-Sobelga and P. Podolec and S. Wisniowska-Smialek and A. Trybuch and P. Hoffman and A. Cichocka-Radwan and S. Sobczak and U. Faflik and A. Tomaszuk-Kazberuk and J. Przepiesc and M. Gil and K. Plaskota and N. Guerra and {de Sousa}, L. and V. Petrescu and C. Ginghina and R. Jurcut and Coman, {I. Mircea} and Gaisin, {I. Ravilevich} and Shilina, {L. Valeryevna} and N. Sharashkina and O. Tkacheva and D. Ivanov and O. Irtyuga and L. Jovovic and K. Prokselj and M. Kozelj and C. Elliott and L. Galian-Gay and A. Pijuan-Domenech and Subirana-Domenech, {M. T.} and P. Tornos and N. Murga and Oliver, {J. M.} and P. Escribano-Sub{\'i}as and Ruiz-Cano, {M. J.} and J. Delgado-Jim{\'e}nez and E. Furenas and M. Dellborg and U. Thil{\'e}n and M. Schwerzmann and J. Bouchardy and T. Rutz and D. Tobler and L. Sarac and Esen, {O. B.} and Enar, {S. C.} and {Al Mulla}, A. and N. Bazargani and {Al Hatou}, E. and F. Farook and B. Salih and P. Clifford and N. Bowers and G. Veldtman and J. Kerr and L. Tellett and L. Hudsmith and P. Thompson and S. Thorne and S. Bowater and P. Nihoyannopoulos and R. Curry and L. Freeman and F. Schroeder and R. Wendler and S. Hammond and C. Talluto and D. Murphy and Perlroth, {M. G.} and K. Chintala and P. Gupta and E. Pare and N. Khatri and N. Scott and {De Faria-Yeh}, D. and Bhatt, {A. B.} and S. Tsiaras and M. Gurvitz and C. Otto and J. Botti and J. Ting and Davidson, {W. R.}",

note = "Publisher Copyright: {\textcopyright} 2015 American Heart Association, Inc.",

year = "2015",

month = jul,

day = "14",

doi = "10.1161/CIRCULATIONAHA.115.015242",

language = "English (US)",

volume = "132",

pages = "132--142",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Pregnancy in Women with a Mechanical Heart Valve

AU - Van Hagen, Iris M.

AU - Roos-Hesselink, Jolien W.

AU - Ruys, Titia P.E.

AU - Merz, Waltraut M.

AU - Goland, Sorel

AU - Gabriel, Harald

AU - Lelonek, Malgorzata

AU - Trojnarska, Olga

AU - Al Mahmeed, Wael Abdulrahman

AU - Balint, Hajnalka Olga

AU - Ashour, Zeinab

AU - Baumgartner, Helmut

AU - Boersma, Eric

AU - Johnson, Mark R.

AU - Hall, Roger

AU - Ferrari, Roberto

AU - Maggioni, Aldo P.

AU - Marelli, Ariane

AU - Webb, Gary

AU - Kaemmerer, Harald

AU - Popelova, Jana

AU - Sliwa, Karen

AU - Tavazzi, Luigi

AU - Parsonage, William Anthony

AU - Stein, Joerg

AU - Elkayam, Uri

AU - Thilen, Ulf

AU - Budts, Werner

AU - Vardas, Panos

AU - Komajda, Michel

AU - Pinto, Fausto

AU - Alonso, Angeles

AU - Wood, David

AU - Maniadakis, Nikolaos

AU - Ferreira, Thierry

AU - Gracia, Gérard

AU - Laroche, Cécile

AU - Missiamenou, Viviane

AU - Taylor, Charles

AU - Konte, Marème

AU - Andarala, Maryna

AU - Fiorucci, Emanuela

AU - Lefrancq, Elin Folkesson

AU - Glémot, Myriam

AU - McNeill, Patti Ann

AU - Pommier, Caroline

AU - Lafay, Myriam

AU - Aquieri, A.

AU - Vega, H. Ruda

AU - Blanco, M. Vázquez

AU - Lust, K.

AU - Fagermo, N.

AU - Donhauser, E.

AU - Gasimov, Z.

AU - Jahangirov, T.

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AU - Davidson, W. R.

PY - 2015/7/14

Y1 - 2015/7/14

N2 - Background - Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results - Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). Conclusions - Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive prepregnancy counseling and centralization of care.

AB - Background - Pregnant women with a mechanical heart valve (MHV) are at a heightened risk of a thrombotic event, and their absolute need for adequate anticoagulation puts them at considerable risk of bleeding and, with some anticoagulants, fetotoxicity. Methods and Results - Within the prospective, observational, contemporary, worldwide Registry of Pregnancy and Cardiac disease (ROPAC), we describe the pregnancy outcome of 212 patients with an MHV. We compare them with 134 patients with a tissue heart valve and 2620 other patients without a prosthetic valve. Maternal mortality occurred in 1.4% of the patients with an MHV, in 1.5% of patients with a tissue heart valve (P=1.000), and in 0.2% of patients without a prosthetic valve (P=0.025). Mechanical valve thrombosis complicated pregnancy in 10 patients with an MHV (4.7%). In 5 of these patients, the valve thrombosis occurred in the first trimester, and all 5 patients had been switched to some form of heparin. Hemorrhagic events occurred in 23.1% of patients with an MHV, in 5.1% of patients with a tissue heart valve (P<0.001), and in 4.9% of patients without a prosthetic valve (P<0.001). Only 58% of the patients with an MHV had a pregnancy free of serious adverse events compared with 79% of patients with a tissue heart valve (P<0.001) and 78% of patients without a prosthetic valve (P<0.001). Vitamin K antagonist use in the first trimester compared with heparin was associated with a higher rate of miscarriage (28.6% versus 9.2%; P<0.001) and late fetal death (7.1% versus 0.7%; P=0.016). Conclusions - Women with an MHV have only a 58% chance of experiencing an uncomplicated pregnancy with a live birth. The markedly increased mortality and morbidity warrant extensive prepregnancy counseling and centralization of care.

KW - heart defects congenital

KW - heart valves

KW - pregnancy

KW - prostheses and implants

KW - thrombosis

UR - http://www.scopus.com/inward/record.url?scp=84937569037&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937569037&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.115.015242

DO - 10.1161/CIRCULATIONAHA.115.015242

M3 - Article

C2 - 26100109

AN - SCOPUS:84937569037

SN - 0009-7322

VL - 132

SP - 132

EP - 142

JO - Circulation

JF - Circulation

IS - 2

ER -

Pregnancy in Women with a Mechanical Heart Valve

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