Mechanical aortic valves during pregnancy were uniquely associated with maternal death (1.1%) and valve thrombosis (4.9%), and had a lower liveborn delivery rate (71.7%) than tissue valves.
Does the choice of aortic valve substitute affect maternal, valvular, and foetal outcomes during pregnancy in women requiring AVR?
In young women requiring aortic valve replacement, mechanical valves are associated with higher risks of maternal mortality and valve thrombosis during pregnancy, as well as lower live birth rates, compared to tissue valves or autografts.
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Abstract OBJECTIVES To investigate the optimal valve substitute for young women requiring aortic valve replacement (AVR), allowing improved future valve-related outcomes for mother and foetus during pregnancy. METHODS A systematic search was performed for publications between 1998–2025 reporting women experiencing pregnancy after AVR with a pulmonary autograft (Ross-procedure), homograft, bioprosthesis (xenograft) or mechanical valve. Pooled proportions were calculated to determine maternal, valvular and foetal outcomes during pregnancy using generalized linear mixed models. RESULTS Thirteen studies reporting 356 pregnancies in 251 women(pooled mean age at pregnancy 29.1 ± 4.8 years) after AVR with a pulmonary autograft (70 women, 119 pregnancies), homograft (73 women, 99 pregnancies), bioprosthesis (37 women, 50 pregnancies), or mechanical valve (71 women, 88 pregnancies) were included. During pregnancy, valve-related reintervention in women with a bioprosthesis was 2.7%(95% CI : 0.4–16.9) at 5.1 ± 2.5 years after AVR. This was not observed in women with pulmonary autografts (7.7 ± 4.2 years after AVR) and homografts(4.1 ± 3.3 years after AVR). Reintervention for valve thrombosis(4.9%(95% CI : 1.6–14.0)) and maternal death(1.1%(95% CI : 0.2–7.6)) occurred only in women with mechanical valves(8.1 ± 4.5 years after AVR). Pooled probability of liveborn delivery was 71.7%(95% CI : 59.2–81.6) in women with a mechanical valve, compared to 90.6%(95% CI: 72.4–97.3), 92.3%(95% CI : 56.0–99.1) and 82.9%(95% CI : 53.3–95.4) in women with an autograft, homograft or bioprosthesis respectively. CONCLUSIONS Maternal mortality and valve thrombosis during pregnancy occurred only in women with mechanical valves. Although no statistical comparisons were made, pregnancies in women with pulmonary autograft, homograft or bioprosthesis showed acceptable maternal and foetal outcomes. These descriptive findings provide foundations for further investigation of tissue-valve function before, during and after pregnancy, aiming for more support of current guidelines.
Khargi et al. (Wed,) reported a other. Mechanical aortic valves during pregnancy were uniquely associated with maternal death (1.1%) and valve thrombosis (4.9%), and had a lower liveborn delivery rate (71.7%) than tissue valves.
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