Pregnancy Has
No Effect on the Rate of Structural Deterioration of Bioprosthetic Valves:
Long-term 18-year Follow Up Results
Fayez El Shaer, Walid Hassan, Bendehiba Latroche,
Sumaya Helaly, Hesham Hegazy, Maie Shahid, Gamal Mohamed, Zohair Al-Halees
King Faisal Heart Institute, Department of Biostatistics,
Epidemiology and Scientific Computing, King Faisal Specialist Hospital
and Research Centre, Riyadh, Saudi Arabia |
Background and aim of the study: Should cardiac
valve replacement be required, a bioprosthetic valve (BPV) is generally
recommended for female patients of childbearing age to avoid anticoagulation
hazards. Whether pregnancy accelerates BPV degeneration, or not, remains
the subject of debate. The study aim was to determine the long-term effects
of repeat pregnancy on the rate of structural deterioration of BPVs.
Methods: Eighty-five female patients of childbearing age
who underwent BPV replacement between 1986 and 2000 were allocated
to two groups: group P (n = 49; mean age 25 ± 6 years) who
became pregnant (144 pregnancies), and group NP (n = 36; mean age
27 ± 7 years) who never became pregnant. The general characteristics
of both groups were comparable. Clinical and echocardiographic
data were obtained annually for all subjects; the mean follow up
for all patients was 8.5 ±
3.8 years (range: 4.6-18.4 years). Group P received 59 (68% mitral) BPVs,
while group NP received 45 (60% mitral). The majority of BPVs were Hancock
II® porcine bioprostheses. The end-point
|
was freedom from redo valve replacement due to structural
valve deterioration (SVD).
Results: No major maternal complications were encountered. A total
of 144 pregnancies resulted in 114 live deliveries (79%). During the
follow up period, 30 patients required reoperation for SVD (23 (46.9%)
in group P; seven (19.4%) in group NP). The mean valve survival time
for groups P and NP was 11.5 ± 7 years and 13 ± 9 years,
respectively. A test of freedom from redo surgery for SVD in both groups
demonstrated no significant differences between the P and NP groups (RR
1.8; 95% CI = 0.761-4.256; p = 0.18). Further analysis testing the potential
effect of increased number of pregnancies on the duration to redo surgery
among P group showed no effect.
Conclusion: Up to 18 years’ follow up of patients with a BPV and
repeated pregnancy showed there to be no pregnancy-related accelerated
degeneration of BPVs. In addition, fetal loss rates were most likely lower
with the use of BPVs.
The Journal of Heart Valve Disease 2005;14:481-485 |