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 | |
| State | Published - Jul 14 2015 |
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
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Pregnancy in Women with a Mechanical Heart Valve. / Van Hagen, Iris M.; Roos-Hesselink, Jolien W.; Ruys, Titia P.E.; Merz, Waltraut M.; Goland, Sorel; Gabriel, Harald; Lelonek, Malgorzata; Trojnarska, Olga; Al Mahmeed, Wael Abdulrahman; Balint, Hajnalka Olga; Ashour, Zeinab; Baumgartner, Helmut; Boersma, Eric; Johnson, Mark R.; Hall, Roger; Ferrari, Roberto; Maggioni, Aldo P.; Marelli, Ariane; Webb, Gary; Kaemmerer, Harald; Popelova, Jana; Sliwa, Karen; Tavazzi, Luigi; Parsonage, William Anthony; Stein, Joerg; Elkayam, Uri; Thilen, Ulf; Budts, Werner; Vardas, Panos; Komajda, Michel; Pinto, Fausto; Alonso, Angeles; Wood, David; Maniadakis, Nikolaos; Ferreira, Thierry; Gracia, Gérard; Laroche, Cécile; Missiamenou, Viviane; Taylor, Charles; Konte, Marème; Andarala, Maryna; Fiorucci, Emanuela; Lefrancq, Elin Folkesson; Glémot, Myriam; McNeill, Patti Ann; Pommier, Caroline; Lafay, Myriam; Aquieri, A.; Vega, H. Ruda; Blanco, M. Vázquez; 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, C. Vilas; Chilingirova, N.; Kratunkov, P.; Montesclaros, A. R.; Beaubien, E.; Gordon, E.; Walter, L.; Lindsay, C.; Wahab, N.; Vavera, Z.; El Nagar, A. E.; Ebaid, H. H.; El Sayed Makled, W. A.; Taha, N.; Dardier, A.; Shabaan, M.; Elrakshy, Y.; Eltamawey, K.; Abd-El Aziz, M. Gamal; Saad, A.; Aboleineen, W.; Sorour, K.; Mahdy, M. A.Meguid; 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, A. Vazan; Shotan, A.; Festa, P.; Ali, L. Ait; Sinagra, G.; Puggia, I.; Mottolese, B. D.Agata; Carmina, M. G.; 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, J. M.J.; van Dijk, A.; Bellersen, L.; Duijnhouwer, T.; De Groot, C.; Pieper, E. P.G.; 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, I. Mircea; Gaisin, I. Ravilevich; Shilina, L. Valeryevna; Sharashkina, N.; Tkacheva, O.; Ivanov, D.; Irtyuga, O.; Jovovic, L.; Prokselj, K.; Kozelj, M.; Elliott, C.; Galian-Gay, L.; Pijuan-Domenech, A.; Subirana-Domenech, M. T.; Tornos, P.; Murga, N.; Oliver, J. M.; Escribano-Subías, P.; Ruiz-Cano, M. J.; Delgado-Jiménez, J.; Furenas, E.; Dellborg, M.; Thilén, U.; Schwerzmann, M.; Bouchardy, J.; Rutz, T.; Tobler, D.; Sarac, L.; Esen, O. B.; Enar, S. C.; 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, M. G.; Chintala, K.; Gupta, P.; Pare, E.; Khatri, N.; Scott, N.; De Faria-Yeh, D.; Bhatt, A. B.; Tsiaras, S.; Gurvitz, M.; Otto, C.; Botti, J.; Ting, J.; Davidson, W. R.
In: Circulation, Vol. 132, No. 2, 14.07.2015, p. 132-142.Research output: Contribution to journal › Article › peer-review
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.
AU - Hasanova, I.
AU - De Backer, J.
AU - Demulier, L.
AU - de Hosson, M.
AU - Beckx, M.
AU - Moissens, M.
AU - Kovacevic-Preradovic, T.
AU - Kozic, M.
AU - Lovric, M.
AU - Freire, C. Vilas
AU - Chilingirova, N.
AU - Kratunkov, P.
AU - Montesclaros, A. R.
AU - Beaubien, E.
AU - Gordon, E.
AU - Walter, L.
AU - Lindsay, C.
AU - Wahab, N.
AU - Vavera, Z.
AU - El Nagar, A. E.
AU - Ebaid, H. H.
AU - El Sayed Makled, W. A.
AU - Taha, N.
AU - Dardier, A.
AU - Shabaan, M.
AU - Elrakshy, Y.
AU - Eltamawey, K.
AU - Abd-El Aziz, M. Gamal
AU - Saad, A.
AU - Aboleineen, W.
AU - Sorour, K.
AU - Mahdy, M. A.Meguid
AU - Iserin, L.
AU - Ladouceur, M.
AU - Cohen, S.
AU - Iung, B.
AU - Maisuradze, D.
AU - Mebus, S.
AU - Gembruch, U.
AU - Hammerstingl, C.
AU - Wald, C.
AU - Orwat, S.
AU - Schmidt, R.
AU - Motz, R.
AU - Olsson, A.
AU - Berger, F.
AU - Nagdyman, N.
AU - Frogoudaki, A.
AU - Anastasiou-Nana, M.
AU - Temesvari, A.
AU - Kohalmi, D.
AU - Merkely, B.
AU - Liptai, C.
AU - Bowen, M.
AU - Cullen, M.
AU - Thornton, P.
AU - Husarova, V.
AU - Blatt, A.
AU - Elbaz-Greener, G.
AU - Moravsky, G.
AU - Vered, Z.
AU - Fuhrmann, A. Vazan
AU - Shotan, A.
AU - Festa, P.
AU - Ali, L. Ait
AU - Sinagra, G.
AU - Puggia, I.
AU - Mottolese, B. D.Agata
AU - Carmina, M. G.
AU - Romeo, C.
AU - Crepaz, R.
AU - Fesslova, V.
AU - Azzarelli, A.
AU - Baldi, D.
AU - Bovenzi, F.
AU - Donvito, V.
AU - Vasario, E.
AU - Todros, T.
AU - Niwa, K.
AU - Mussagaliyeva, A.
AU - Mekebekova, D.
AU - Sharipova, S.
AU - Zaliunas, R.
AU - Jonkaitiene, R.
AU - Petrauskaite, J.
AU - Gumbiene, L.
AU - Jovanova, S.
AU - Cassar, A.
AU - Caruana, M.
AU - Karamermer, Y.
AU - Cornette, J. M.J.
AU - van Dijk, A.
AU - Bellersen, L.
AU - Duijnhouwer, T.
AU - De Groot, C.
AU - Pieper, E. P.G.
AU - van Oppen, C.
AU - Polak, P.
AU - Wajon, E.
AU - Wagenaar, L.
AU - Estensen, M.
AU - Lesniak-Sobelga, A.
AU - Podolec, P.
AU - Wisniowska-Smialek, S.
AU - Trybuch, A.
AU - Hoffman, P.
AU - Cichocka-Radwan, A.
AU - Sobczak, S.
AU - Faflik, U.
AU - Tomaszuk-Kazberuk, A.
AU - Przepiesc, J.
AU - Gil, M.
AU - Plaskota, K.
AU - Guerra, N.
AU - de Sousa, L.
AU - Petrescu, V.
AU - Ginghina, C.
AU - Jurcut, R.
AU - Coman, I. Mircea
AU - Gaisin, I. Ravilevich
AU - Shilina, L. Valeryevna
AU - Sharashkina, N.
AU - Tkacheva, O.
AU - Ivanov, D.
AU - Irtyuga, O.
AU - Jovovic, L.
AU - Prokselj, K.
AU - Kozelj, M.
AU - Elliott, C.
AU - Galian-Gay, L.
AU - Pijuan-Domenech, A.
AU - Subirana-Domenech, M. T.
AU - Tornos, P.
AU - Murga, N.
AU - Oliver, J. M.
AU - Escribano-Subías, P.
AU - Ruiz-Cano, M. J.
AU - Delgado-Jiménez, J.
AU - Furenas, E.
AU - Dellborg, M.
AU - Thilén, U.
AU - Schwerzmann, M.
AU - Bouchardy, J.
AU - Rutz, T.
AU - Tobler, D.
AU - Sarac, L.
AU - Esen, O. B.
AU - Enar, S. C.
AU - Al Mulla, A.
AU - Bazargani, N.
AU - Al Hatou, E.
AU - Farook, F.
AU - Salih, B.
AU - Clifford, P.
AU - Bowers, N.
AU - Veldtman, G.
AU - Kerr, J.
AU - Tellett, L.
AU - Hudsmith, L.
AU - Thompson, P.
AU - Thorne, S.
AU - Bowater, S.
AU - Nihoyannopoulos, P.
AU - Curry, R.
AU - Freeman, L.
AU - Schroeder, F.
AU - Wendler, R.
AU - Hammond, S.
AU - Talluto, C.
AU - Murphy, D.
AU - Perlroth, M. G.
AU - Chintala, K.
AU - Gupta, P.
AU - Pare, E.
AU - Khatri, N.
AU - Scott, N.
AU - De Faria-Yeh, D.
AU - Bhatt, A. B.
AU - Tsiaras, S.
AU - Gurvitz, M.
AU - Otto, C.
AU - Botti, J.
AU - Ting, J.
AU - Davidson, W. R.
N1 - Publisher Copyright: © 2015 American Heart Association, Inc.
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.
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
VL - 132
SP - 132
EP - 142
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 2
ER -