Mechanical versus biological prosthetic heart valves in pregnant women with valvular heart disease

WU Shu-yan; HAN Feng-zhen

摘要：The pregnant women with a prosthetic heart valve(PHV)are considered to have a higher risk of cardiovascular,obstetric and fetal/neonatal complications when they underwent anticoagulation therapy in all 3 trimesters.This report evaluated the comparative results of pregnant women wearing mechanical and biological PHV.Methods The outcomes of different types of PHV were assessed retrospectively in pregnant women in Guangdong Provincial People's Hospital from January 2008 to May 2021.A total of 243 women(319 pregnan-cies)were enrolled and divided into mechanical PHV group and biological PHV group according to the types of PHV implanted.The baseline data of all pregnancies were studied.Cardiovascular,obstetric and fetal/neonatal complications in 201 completed pregnancies of 165 women with different PHV were analyzed.Results 319 pregnancies occurred,of which 201 pregnancies(165 women)≥20 weeks duration,including 159 pregnancies with mechanical PHV and 42 pregnancies with biological PHV.Miscarriages were more common in women with mechanical PHV[40 pregnancies(14.65％),≤20 weeks],while only one case was noted in women with biologi-cal PHV(P＜0.05).The induced abortion rate of women with mechanical PHV(27.11％vs.6.52％,P＜0.05)was significantly higher compared with that in women with biological PHV.The incidence of cardiovascular,obstet-ric and fetal/neonatal complications was equally frequent in both groups after 20 weeks of gestation.Conclu-sions Pregnant women with mechanical PHV were more likely to have a complication of miscarriages than those with biological PHV,mainly due to the anticoagulation therapy.On the other hand,more women with me-chanical PHV may choose not to become pregnant than women with biological PHV after counseling the risks of pregnancy.There was no significant difference in other aspects of maternal and fetal complications after 20 weeks of gestation.Women who cannot maintain therapeutic anticoagulation and frequent monitoring of mechani-cal PHV may consider biological PHV.