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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Pregnancy Outcomes in Women with Mechanical Heart Valves: Twenty-year´s Experience of a Tertiary Centre
Session:
Painel 10 - Doença Valvular 4
Speaker:
Vera Vaz Ferreira
Congress:
CPC 2020
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.7 Pregnancy and Cardiovascular Disease
Session Type:
Posters
FP Number:
---
Authors:
Vera Ferreira; André Viveiros Monteiro; Marta Plancha Santos; Alexandra Castelo; Pedro Garcia Brás; Tânia Branco Mano; João Pedro Reis; Ana Isabel Machado; Augusta Borges; Maria José Alves; Lidia De Sousa; Lino Patrício ; Rui Cruz Ferreira
Abstract
<p><strong>Background</strong><strong>:</strong> Mechanical heart valves (MHV) and their absolute need for adequate anticoagulation poses a challenge for pregnancy, either due to warfarin fetotoxicity or an increased risk of maternal thromboembolism. This represents a unique patient (P) group where data is scarce and maternal and fetal risks and benefits must be carefully weighed. </p> <p><strong>Purpose:</strong> To assess maternal and perinatal outcomes in women with MHV on different anticoagulant regimens and compare them with patients with other types of valvular heart disease (VHD).</p> <p><strong>Methods:</strong> A retrospective analysis of 131 pregnancies in 83 women with VHD (mean age 26.5 ± 5.6 years) was carried out in a tertiary referral centre from 2000 to 2019. 92 pregnancies with VHD, including 11 with biological prosthetic valves, and 39 pregnancies in 22 P with MHV were identified. The main outcome measures were major maternal complications and perinatal outcome.</p> <p><strong>Results:</strong> MHV implanted were in mitral position (89.7%), aortic (2.6%), or both (7.7%). History of rheumatic heart disease was identified in 16 P (72.7%) and a congenital etiology was present in 2 P (9.1%). 9 P (40.9%) were on warfarine and 13 P(59.1%) on acenocumarol. Regarding anticoagulation strategy, 21 P (65.6 %) remained on oral anticoagulation and 10 P (31.3%) had been switched to some form of heparin during part or the entire pregnancy. Mechanical valve thrombosis complicated pregnancy in 4 P (10.2%), all cases on heparin, and resulted in maternal death in 1 P. MHV P had more hemorrhagic complications (15.4 vs 2.2%, p= 0.004) requiring transfusion or surgical revision. MHV P tended to experience more NHYA class worsening demanding initiation or intensification of cardiac medication (17.9 vs 5.4%, p=0.023). Also in the MHV group there was a higher incidence of miscarriage (46.2 vs 12.0%, p<0.0005), comprising spontaneous abortion (31.6 vs 7.6%, p<0.0005) and fetal malformations (18.4 vs 5.4%, p=0.028), including warfarin embryopathy (10.3 vs 1.1%, p=0.012). The live birth rate was higher in women on heparin compared with those on vitamin K antagonists (85.9 vs 79.2%, p=0.002). The presence of multivalve disease (p=0.04), mechanical protheses (p<0.001), ACO (p<0.001) and previous impaired LVEF (p=0.02) were related to miscarriage. In multivariate analysis, ACO was the unique independent predictor of unsuccessful pregnancy (p=0.01). Only 29% of the patients with an MHV had a pregnancy free of serious adverse events compared with other types of VHD (81.5%, p<0.0005).</p> <p><strong>Conclusions:</strong> MHV remains a challenging condition for pregnancy with only 29% chance of experiencing an uncomplicated pregnancy with a live birth. The increased morbimortality warrant extensive prepregnancy counseling with prosthesis type discussion,centralization of care and further larger studies to come up with evidence-based recommendations.</p>
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