To study the outcome of pregnancy in women with
artificial heart valves treated in major European centres, and to compare the safety and efficacy of different
anticoagulant regimens and of mechanical and bioprosthetic valves.
DESIGN: Retrospective study.
METHOD: The information was obtained by questionnaire sent to all major cardiac centres in Europe sending one cardiologist from each centre a covering letter suggesting that the questionnaire be handed on where appropriate to the most relevant colleague.
RESULTS: 214 pregnancies were reported in 182 women; 151 pregnancies in 133 women with mechanical valves, and 63 pregnancies in 45 women with
bioprostheses. Most women were in New York Heart Association class I or II and in sinus rhythm. 150 women with mechanical valves and 11 (17%) with
bioprostheses received
anticoagulants during pregnancy. One patient with an aortic valve
prosthesis refused to take
anticoagulants. Including the
spontaneous abortions reported as well as the
therapeutic abortions 83% of the pregnancies in women with
bioprostheses and 73% in those with mechanical valves resulted in a healthy baby, full term or premature, who did well (NS). The incidence of
stillbirths (3% and 6%) and of reported
spontaneous abortions are excluded (because they are unlikely to have been fully reported), the success rate was 91% for women with bioprosthetic valves and 84% for women with mechanical valves (NS). 114 (53%) of the women had taken
warfarin for some part of the pregnancy (46 (40%) of these during the first trimester) but there were no
embryopathies. There were 13 valve
thromboses (four fatal), eight embolic events (two fatal), and seven bleeds in women with mechanical valves. Most of these complications occurred with
heparin but fatal aortic valve
thrombosis occurred in the one woman who refused
anticoagulant treatment out of the 151 women with mechanical valves. There were no
maternal deaths in the
bioprosthesis group but in 17/49 (35%) of these valves functional deterioration led to urgent replacement during pregnancy (two) or soon after.
CONCLUSIONS: The outcome of pregnancy was similar for women with mechanical valves or
bioprostheses.
Warfarin treatment was safe and effective and was not associated with
embryopathy.
Heparin treatment was associated with more thromboembolic complications and more
bleeding complications.
Bioprostheses deteriorate rapidly during pregnancy.