Risk of pregnancy in moderate and severe aortic stenosis : From the multinational ROPAC registry

Journal article


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. and Baumgartner, Helmut. (2016). Risk of pregnancy in moderate and severe aortic stenosis : From the multinational ROPAC registry. Journal of the American College of Cardiology. 68(16), pp. 1727-1737. https://doi.org/10.1016/j.jacc.2016.07.750
AuthorsOrwat, 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. and Baumgartner, Helmut
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.

Keywordsfetal outcome; heart failure; maternal outcome; risk factors
Year2016
JournalJournal of the American College of Cardiology
Journal citation68 (16), pp. 1727-1737
PublisherElsevier Inc.
ISSN0735-1097
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jacc.2016.07.750
PubMed ID27737738
Scopus EID2-s2.0-84994493675
Research or scholarlyResearch
Page range1727-1737
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online10 Oct 2016
Publication process dates
Accepted12 Jul 2016
Deposited20 Jan 2022
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