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 language | English (US) |
|---|---|
| Pages (from-to) | 1727-1737 |
| Number of pages | 11 |
| Journal | Journal of the American College of Cardiology |
| Volume | 68 |
| Issue number | 16 |
| DOIs | |
| State | Published - Oct 18 2016 |
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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Risk of Pregnancy in Moderate and Severe Aortic Stenosis : From the Multinational ROPAC Registry. / Orwat, Stefan; Diller, Gerhard Paul; van Hagen, Iris M.; Schmidt, Renate; Tobler, Daniel; Greutmann, Matthias; Jonkaitiene, Regina; Elnagar, Amro; Johnson, Mark R.; Hall, Roger; Roos-Hesselink, Jolien W.; Baumgartner, Helmut; 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; Ruys, Titia; 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.; Gabriel, H.; 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.; 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.; Ashour, Z.; Sorour, K.; Mahdy, M. A.Meguid; Iserin, L.; Ladouceur, M.; Cohen, S.; Iung, B.; Maisuradze, D.; Mebus, S.; Gembruch, U.; Hammerstingl, C.; Merz, W. M.; Wald, C.; Motz, R.; Olsson, A.; Berger, F.; Nagdyman, N.; Frogoudaki, A.; Anastasiou-Nana, M.; Temesvari, A.; Kohalmi, D.; Balint, H.; 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.; Goland, S.; 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.; 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.; Lelonek, M.; Sobczak, S.; Faflik, U.; Tomaszuk-Kazberuk, A.; Przepiesc, J.; Gil, M.; Plaskota, K.; Trojnarska, O.; 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.; Sarac, L.; Esen, O. Batukan; Enar, S. Catirli; Al Mulla, A.; Bazargani, N.; Al Hatou, E.; Farook, F.; Almahmeed, W.; 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: Journal of the American College of Cardiology, Vol. 68, No. 16, 18.10.2016, p. 1727-1737.Research output: Contribution to journal › Article
TY - JOUR
T1 - Risk of Pregnancy in Moderate and Severe Aortic Stenosis
T2 - From the Multinational ROPAC Registry
AU - Orwat, Stefan
AU - Diller, Gerhard Paul
AU - van Hagen, Iris M.
AU - Schmidt, Renate
AU - Tobler, Daniel
AU - Greutmann, Matthias
AU - Jonkaitiene, Regina
AU - Elnagar, Amro
AU - Johnson, Mark R.
AU - Hall, Roger
AU - Roos-Hesselink, Jolien W.
AU - Baumgartner, Helmut
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 - Ruys, Titia
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 - Gabriel, H.
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.
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 - Ashour, Z.
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 - Merz, W. M.
AU - Wald, C.
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 - Balint, H.
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 - Goland, S.
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 - 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 - Lelonek, M.
AU - Sobczak, S.
AU - Faflik, U.
AU - Tomaszuk-Kazberuk, A.
AU - Przepiesc, J.
AU - Gil, M.
AU - Plaskota, K.
AU - Trojnarska, O.
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 - Sarac, L.
AU - Esen, O. Batukan
AU - Enar, S. Catirli
AU - Al Mulla, A.
AU - Bazargani, N.
AU - Al Hatou, E.
AU - Farook, F.
AU - Almahmeed, W.
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.
PY - 2016/10/18
Y1 - 2016/10/18
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84994493675&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84994493675&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2016.07.750
DO - 10.1016/j.jacc.2016.07.750
M3 - Article
C2 - 27737738
AN - SCOPUS:84994493675
VL - 68
SP - 1727
EP - 1737
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 16
ER -