Clinical pregnancy outcomes in women with mechanical prosthetic valves

Abstract

Introduction: pregnant women with mechanical prosthetic valves (MPVs) have a higher risk of complications. We set out to identify and describe the main complications of pregnant women with MPVs, whether these are preventable, and  their impact on cardiovascular, obstetric and fetal outcomes. 

Materials and methods   an analytical, observational study of a prospective cohort at a cardiac-obstetric clinic. The registry began in January 2016 and continues to date. This study reports the main cardiovascular, fetal and obstetric outcomes in pregnant women with MVPs included in the registry up to November 2021. We evaluated maternal, cardiac, obstetric, neonatal and safety outcomes.

Results: from January 1, 2016, to November 1, 2021, 22 patients with a mechanical prosthetic valve who underwent 22 pregnancies were included in the REMEC. The mean age was 26.5 years (IQR 14-40). The median CARPREG II was 6 points, 86% were classified as mWHO class III and 14% were in class IV; 72.7% (16) had inadequate anticoagulation on admission, 18.1% (4) were not on any anticoagulant on admission, 40.9% (9) used VKAs and 40.9% (9) were on low molecular weight heparin. There was a 100% survival rate during follow up; however, the rate of complications was high. We found only four women (18%) with no obstetric or neonatal primary or secondary cardiac outcome. Primary cardiac events occurred in 18.1% of the patients, secondary cardiac events in 13%, obstetric outcomes in three (13.6%) and neonatal events in 45.4% (10). Fifty-nine percent of the patients had late evaluations. We found mechanical valve thrombosis in 36.3%.

Conclusions: in our experience, although all the pregnant women survived, the rate of compli­cations was high, with a higher proportion of neonatal complications. We found a high percentage of late evaluation, inadequate anticoagulation and preventable events.