Valve replacement during pregnancy: literature review including new data from the Registry Of Pregnancy And Cardiac disease III

Abstract

Objectives: Heart valve replacement during pregnancy is sometimes unavoidable, and the need for anticoagulation further complicates these procedures. Our study describes cases of valve replacement in pregnancy enrolled in the Registry Of Pregnancy And Cardiac disease (ROPAC) III and gives an overview of the published literature. Methods: We performed a systematic review with new data from the ROPAC III and data available in the literature. ROPAC III is a global, prospective, observational registry that included pregnant women with 1 or more prosthetic valves between January 2018 and April 2023. Electronic databases were searched for studies enrolling pregnant women who underwent valve replacement during pregnancy with a fetus in utero. The primary outcomes were maternal and fetal death. Mixed-effect logistic regression models were used to identify predictors for maternal and fetal mortality. Results: A valve replacement was performed in 11 pregnancies. The mother and fetus died in 1 case, and in 2 cases, reversible postoperative complications occurred. We found 74 cases in the literature and calculated an overall maternal and fetal death rate of 9% and 34%, respectively. All maternal deaths occurred in women with a replacement of a prosthetic valve in mitral position. We found valve replacement in the 1st trimester (OR 10.0) and acute malfunctioning of an existing prosthetic valve (OR 19.7) as predictors for maternal mortality, and replacement of an existing prosthetic valve (OR 4.8) as predictor for fetal mortality. Conclusions: Valve replacement during pregnancy carries a high maternal and fetal death, especially in women who need a replacement of an existing prosthetic valve.