Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry

Stefan Orwat, Gerhard Paul Diller, Iris M. van Hagen, Renate Schmidt, Daniel Tobler, Matthias Greutmann, Regina Jonkaitiene, Amro Elnagar, Mark R. Johnson, Roger Hall, Jolien W. Roos-Hesselink, Helmut Baumgartner, Roberto Ferrari, Aldo P. Maggioni, Ariane Marelli, Gary Webb, Harald Kaemmerer, Jana Popelova, Karen Sliwa, Luigi TavazziWilliam Anthony Parsonage, Joerg Stein, Uri Elkayam, Ulf Thilen, Werner Budts, Titia Ruys, 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, H. Gabriel, 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. 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, Z. Ashour, K. Sorour, M. A.Meguid Mahdy, L. Iserin, M. Ladouceur, S. Cohen, B. Iung, D. Maisuradze, S. Mebus, U. Gembruch, C. Hammerstingl, W. M. Merz, C. Wald, R. Motz, A. Olsson, F. Berger, N. Nagdyman, A. Frogoudaki, M. Anastasiou-Nana, A. Temesvari, D. Kohalmi, H. Balint, 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, S. Goland, 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, 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, M. Lelonek, S. Sobczak, U. Faflik, A. Tomaszuk-Kazberuk, J. Przepiesc, M. Gil, K. Plaskota, O. Trojnarska, 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, L. Sarac, O. Batukan Esen, S. Catirli Enar, A. Al Mulla, N. Bazargani, E. Al Hatou, F. Farook, W. Almahmeed, 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, Emmanuelle 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

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Background Controversial results on maternal risk and fetal outcome have been reported in women with aortic stenosis (AS). Objectives The authors sought to investigate maternal and fetal outcomes in patients with AS in a large cohort. Methods The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective observational registry of women with structural heart disease, providing a uniquely large study population. Data of women with moderate (peak gradient 36 to 63 mm Hg) and severe AS (peak gradient ≥64 mm Hg) were analyzed. Results Of 2,966 pregnancies in ROPAC, the authors identified 96 women who had at least moderate AS (34 with severe AS). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women were hospitalized for cardiac reasons during pregnancy. This was significantly more common in severe AS compared with moderate AS (35.3% vs. 12.9%; p = 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed medically, except for 1 patient who was symptomatic before pregnancy and underwent balloon valvotomy. Children of patients with severe AS had a significantly higher percentage of low birth weight (35.0% vs. 6.0%; p = 0.006). Conclusions Mortality in pregnant women with AS, including those with severe AS, appears to be close to zero in the current era. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with high rates of hospitalization for cardiac reasons, although heart failure can nearly always be managed medically. The results highlight the importance of appropriate pre-conceptional patient evaluation and counseling.

Original languageEnglish (US)
Pages (from-to)1727-1737
Number of pages11
JournalJournal of the American College of Cardiology
Volume68
Issue number16
DOIs
StatePublished - Oct 18 2016

Keywords

  • fetal outcome
  • heart failure
  • maternal outcome
  • risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry'. Together they form a unique fingerprint.

  • Cite this

    Orwat, S., Diller, G. P., van Hagen, I. M., Schmidt, R., Tobler, D., Greutmann, M., Jonkaitiene, R., Elnagar, A., Johnson, M. R., Hall, R., Roos-Hesselink, J. W., Baumgartner, H., Ferrari, R., Maggioni, A. P., Marelli, A., Webb, G., Kaemmerer, H., Popelova, J., Sliwa, K., ... Davidson, W. R. (2016). Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry. Journal of the American College of Cardiology, 68(16), 1727-1737. https://doi.org/10.1016/j.jacc.2016.07.750