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The Surge

Clinical, training, product and patient outcome resources for cardiac surgeons and their heart team partners

Medical Professional touching digital screen with a heart
Medical Professional touching digital screen with a heart
Medical Professional touching digital screen with a heart
May 26, 2023

Pregnancy and Heart Valve Selection Considerations

Pregnancy
Pregnancy
Pregnancy

May is Women’s Health Care Month—the perfect time to remember that improvement in care for chronic and congenital cardiac disease, as well as the delayed age of childbearing, is expected to contribute to an increase in the number of women with heart valve prostheses experiencing pregnancy.1 This article provides an overview of the challenges, considerations, outcomes, choices, and decisions your female patients may want to discuss.

Pregnancy and Valvular Heart Disease (VHD)

Pregnancies in patients with VHD are associated with an increased incidence of adverse outcomes.2  When implantation of a prosthetic valve is required, choosing the proper valve can also be challenging.3

Pregnancy
Pregnancy
Pregnancy

Decision considerations

There are multiple factors to consider when selecting a prosthetic valve for pregnant patients or those considering pregnancy, including:

  1. Valve types—and known advantages and disadvantages.
  2. Patient preferences—and how to optimally integrate this information into the clinical characteristics and personal lifestyle considerations of each patient.4,5

Valve material matters

The chart below provides an overview of the advantages and disadvantages of bioprosthetic (tissue) and mechanical valves.

Mechanical vs tissue valve
Mechanical vs tissue valve
Mechanical vs tissue valve

Valves and pregnancy outcomes

In a study that evaluated pregnant women with a prosthetic heart valve, fewer induced abortions and miscarriages were observed in women who received a bioprosthetic heart valve.8

Valves and pregnancy outcomes
Valves and pregnancy outcomes
Valves and pregnancy outcomes

Opportunity for a shared decision

The heart team can work closely with patients to help them understand pregnancy and maternal outcomes, consider their personal preference and lifestyle choices, and discuss the optimal timing and type of valve replacement.6

Mother and child
Mother and child
Mother and child

For additional information on surgical valves go to:

Send your patients to www.yourtissuevalve.com for heart valve disease details.

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Elderly Woman Smiling
Elderly Woman Smiling
Elderly Woman Smiling

References

  1. Lawley C, Algert, C, Ford, J, Nippita T, Figree G, Roberts C. Heart valve prostheses in pregnancy: outcomes for women and their infants. J Am Heart Assoc. 2014;3:e000953.
  2. Nanna M, Steriopoulos K. Pregnancy complicated by valvular heart disease: an update. J Am Heart Assoc. 2014;3:e000712. DOI: 10.1161/JAHA.113.000712.
  3. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of Valvular Heart Disease. European Heart Journal. 2021;43(7):561–632.
  4. Van Hagen IM, Roos-Hesselink JW, Ruys TP, et al. Pregnancy in women with a mechanical heart valve: data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation. 2015;132(2):132-142.
  5. Barbarash L, Rutkovskaya N, Barbarash O, Odarenko Y, Stasev A, Uchasova E. Prosthetic heart valve selection in women of childbearing age with acquired heart disease: a case report. J Med Case Rep. 2016;10:51. DOI 10.1186/s13256-016-0821-y.
  6. Otto M, Nishimura R, Bonow R, et al. 2020 ACC/AHA Guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol. 2021;77-74.
  7. Lawley C, Lain S, Algert C, Ford J, Figtree G, Roberts C. Prosthetic heart valves in pregnancy, outcomes for women and their babies: a systematic review and meta-analysis. BJOG. 2015;122:1446-1455.
  8. Siu SC, Lam M, Allen B, et al. Attained pregnancy among women with a prosthetic heart valve. Eur J Obstet Gynecol Reprod Biol. 2019;240:172-177.
Important Safety Information

Important Safety Information

RESILIA Tissue Devices

Indications: INSPIRIS RESILIA Aortic Valve - For use in replacement of native or prosthetic aortic heart valves. KONECT RESILIA Aortic Valved Conduit - For use in replacement of native or prosthetic aortic heart valves and the associated repair or replacement of a damaged or diseased ascending aorta. MITRIS RESILIA Mitral Valve - For use in replacement of native or prosthetic mitral heart valves.

Contraindications: There are no known contraindications with the use of these RESILIA tissue heart valve devices.

Complications and Side Effects: INSPIRIS RESILIA Aortic Valve - Thromboembolism, valve thrombosis, hemorrhage, hemolysis, regurgitation, endocarditis, structural valve deterioration, nonstructural dysfunction, stenosis, arrhythmia, transient ischemic attack/stroke, congestive heart failure, myocardial infarction, any of which could lead to reoperation, explantation, permanent disability, and death. Additional adverse events potentially associated with the use of polyester vascular grafts in the KONECT RESILIA AVC include hemorrhage, thrombosis, graft infection, embolism, aneurysm, pseudoaneurysm, seroma, occlusion (anastomotic intimal hyperplasia), immunological reaction to collagen (shown to be a weak immunogen; infrequent, mild, localized and self-limiting), intimal peel formation, and conduit dilatation. MITRIS RESILIA Mitral Valve - Thromboembolism, valve thrombosis, hemorrhage, hemolysis, regurgitation, endocarditis, structural valve deterioration, nonstructural dysfunction, stenosis, arrhythmia, transient ischemic attack/stroke, congestive heart failure, myocardial infarction, ventricular perforation by stent posts, any of which could lead to reoperation, explantation, permanent disability, and death.

Warnings: INSPIRIS RESILIA Aortic Valve - DO NOT ADJUST THE VALVE DIAMETER BY EXPANDING THE BAND PRIOR TO OR DURING IMPLANTATION OF THE SURGICAL VALVE. The expandable band is not designed to allow for compression or expansion during implantation of the surgical valve. This will cause damage to the valve and may result in aortic incompetence. DO NOT PERFORM STAND-ALONE BALLOON AORTIC VALVULOPLASTY PROCEDURES ON THIS VALVE FOR THE SIZES 19 – 25 mm as this may expand the valve causing aortic incompetence, coronary embolism or annular rupture. Valve-in-valve sizing in the INSPIRIS valve has only been tested with specific Edwards transcatheter heart valves. Use of other transcatheter valves may result in embolization of transcatheter devices anchored within or result in annular rupture.

CAUTION: Federal (USA) law restricts these devices to sale by or on the order of a physician. See instructions for use for full prescribing information.

Edwards, Edwards Lifesciences, the stylized E logo, INSPIRIS, INSPIRIS RESILIA, KONECT, KONECT RESILIA, MITRIS, MITRIS RESILIA, and RESILIA are trademarks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners.

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