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Mortality in pregnant women with aortic stenosis low in current era
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The risk for mortality among pregnant women with moderate and severe aortic stenosis is “close to zero,” according to new data from the Registry on Pregnancy and Cardiac Disease.
The global, prospective, observational registry was created to collect data on women with structural heart disease. For this study, researchers evaluated data on women with moderate and severe aortic stenosis (AS). Moderate AS was defined as a peak gradient of 36 mm Hg to 63 mm Hg and severe AS as peak gradient of 64 mm Hg or greater.
“The evidence in this setting is ... limited, and the results of published reports are conflicting. Unfortunately, prior studies either encompassed all forms of heart disease or included mild AS. In addition, some series report on historic patient cohorts.
“As a consequence, the reported maternal mortality rate ranges between 2% and 17.4%, and the risk in contemporary cohorts of women presenting with severe AS remains unclear,” Stefan Orwat, MD, from the division of adult congenital and valvular heart disease, department of cardiovascular medicine, University Hospital Muenster, Germany, and colleagues wrote.
The Registry on Pregnancy and Cardiac Disease (ROPAC) included 2,966 pregnancies among women enrolled from 2008 to 2014 at 99 centers in 40 countries. Of those, 96 women had moderate AS and 34 had severe AS. The mean age was 30 years.
None of the women died during pregnancy or in the first week post-delivery. However, during pregnancy, 20.8% required hospitalization for cardiac complications. Hospitalization during pregnancy occurred in 35.3% of women with severe AS and 12.9% of women with moderate AS (P = .02). The rate of hospitalization was 42.1% among women with severe, symptomatic AS.
New or worsening HF and arrhythmias during pregnancy were the most common cardiac complications. There were no occurrences of cerebrovascular complication, deep venous thrombosis, pulmonary embolism or valve thrombosis during pregnancy.
Pregnancy complicated by HF occurred in 26.3% of women with symptomatic AS and 6.7% with asymptomatic AS. HF during pregnancy was managed medically in all patients, except for one women who underwent balloon valvotomy, according to the findings.
In other results, the median pregnancy duration was 38 weeks. Compared with moderate AS, women with severe AS had a higher rate of cesarean section (75% vs. 48.3%; P = .008), preterm birth (< 37 weeks; 35.7% vs. 16%; P = .017) and low birth weight (35% vs. 6%; P = .006).
“The results highlight the importance of appropriate preconceptional patient evaluation and counseling,” Orwat and colleagues concluded.
Afshan B. Hameed, MD, of Maternal Fetal Medicine at University of California, Irvine, and Shahbudin H. Rahimtoola, MB, FRCP, DSc (Hon), of the University of Southern California, Los Angeles, and Keck School of Medicine, discussed the findings in a related editorial published in the Journal of the American College of Cardiology.
“The data in women with moderate AS are clinically important and valuable. One would expect that outcomes in patients with mild AS would be better, or at least similar to those in patients with moderate AS,” they wrote. “More well-designed studies are clearly needed to further our knowledge in this area, which is essential for those with severe AS.” – by Dave Quaile
Disclosure: The researchers and editorial authors report no relevant financial disclosures.
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