Valve Replacement During Pregnancy: Literature Review Including New Data From the Registry of Pregnancy and Cardiac Disease III

Cardiac valve replacement during pregnancy is a high-risk operation that is performed occasionally when indicated. This study queried the Registry of Pregnancy and Cardiac disease (ROPAC) III database, as well as available cases in the literature, and found an overall maternal mortality of 9 percent, while fetal mortality was 34 percent. Maternal mortality occurred in eight cases, all of whom underwent a mitral valve replacement. Predictors of maternal mortality included surgeries performed during the first trimester and acute malfunction of the prosthetic valve. The mean gestational age during delivery was 36.4 weeks in women who underwent cardiac surgery, with a preterm birth at 31.7 percent, and most women delivered via Cesarean section (71 percent). Interestingly, when comparing cases before and after 2010, there was no significant improvement in survival over time. This underscores the importance of preventing valve dysfunction before pregnancy, highlighting the role of preconception assessment and counselling.