Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry

Stefan Orwat; Gerhard Paul Diller; Iris M. van Hagen; Renate Schmidt; Daniel Tobler; Matthias Greutmann; Regina Jonkaitiene; Amro Elnagar; Mark R. Johnson; Roger Hall; Jolien W. Roos-Hesselink; Helmut Baumgartner; Roberto Ferrari; Aldo P. Maggioni; Ariane Marelli; Gary Webb; Harald Kaemmerer; Jana Popelova; Karen Sliwa; Luigi Tavazzi; William Anthony Parsonage; Joerg Stein; Uri Elkayam; Ulf Thilen; Werner Budts; Titia Ruys; Panos Vardas; Michel Komajda; Fausto Pinto; Angeles Alonso; David Wood; Nikolaos Maniadakis; Thierry Ferreira; Gérard Gracia; Cécile Laroche; Viviane Missiamenou; Charles Taylor; Marème Konte; Maryna Andarala; Emanuela Fiorucci; Elin Folkesson Lefrancq; Myriam Glémot; Patti Ann McNeill; Caroline Pommier; Myriam Lafay; A. Aquieri; H. Ruda Vega; M. Vázquez Blanco; K. Lust; N. Fagermo; H. Gabriel; E. Donhauser; Z. Gasimov; T. Jahangirov; I. Hasanova; J. De Backer; L. Demulier; M. de Hosson; M. Beckx; M. Moissens; T. Kovacevic-Preradovic; M. Kozic; M. Lovric; C. Vilas Freire; N. Chilingirova; P. Kratunkov; A. R. Montesclaros; E. Beaubien; E. Gordon; L. Walter; C. Lindsay; N. Wahab; Z. Vavera; A. El Nagar; H. H. Ebaid; W. A. El Sayed Makled; N. Taha; A. Dardier; M. Shabaan; Y. Elrakshy; K. Eltamawey; M. Gamal Abd-El Aziz; A. Saad; W. Aboleineen; Z. Ashour; K. Sorour; M. A.Meguid Mahdy; L. Iserin; M. Ladouceur; S. Cohen; B. Iung; D. Maisuradze; S. Mebus; U. Gembruch; C. Hammerstingl; W. M. Merz; C. Wald; R. Motz; A. Olsson; F. Berger; N. Nagdyman; A. Frogoudaki; M. Anastasiou-Nana; A. Temesvari; D. Kohalmi; H. Balint; B. Merkely; C. Liptai; M. Bowen; M. Cullen; P. Thornton; V. Husarova; A. Blatt; G. Elbaz-Greener; G. Moravsky; Z. Vered; A. Vazan Fuhrmann; A. Shotan; S. Goland; P. Festa; L. Ait Ali; G. Sinagra; I. Puggia; B. D.Agata Mottolese; M. G. Carmina; C. Romeo; R. Crepaz; V. Fesslova; A. Azzarelli; D. Baldi; F. Bovenzi; V. Donvito; E. Vasario; T. Todros; K. Niwa; A. Mussagaliyeva; D. Mekebekova; S. Sharipova; R. Zaliunas; J. Petrauskaite; L. Gumbiene; S. Jovanova; A. Cassar; M. Caruana; Y. Karamermer; J. M.J. Cornette; A. van Dijk; L. Bellersen; T. Duijnhouwer; C. De Groot; E. P.G. Pieper; C. van Oppen; P. Polak; E. Wajon; L. Wagenaar; M. Estensen; A. Lesniak-Sobelga; P. Podolec; S. Wisniowska-Smialek; A. Trybuch; P. Hoffman; A. Cichocka-Radwan; M. Lelonek; S. Sobczak; U. Faflik; A. Tomaszuk-Kazberuk; J. Przepiesc; M. Gil; K. Plaskota; O. Trojnarska; N. Guerra; L. de Sousa; V. Petrescu; C. Ginghina; R. Jurcut; I. Mircea Coman; I. Ravilevich Gaisin; L. Valeryevna Shilina; N. Sharashkina; O. Tkacheva; D. Ivanov; O. Irtyuga; L. Jovovic; K. Prokselj; M. Kozelj; C. Elliott; L. Galian-Gay; A. Pijuan-Domenech; M. T. Subirana-Domenech; P. Tornos; N. Murga; J. M. Oliver; P. Escribano-Subías; M. J. Ruiz-Cano; J. Delgado-Jiménez; E. Furenas; M. Dellborg; U. Thilén; M. Schwerzmann; J. Bouchardy; T. Rutz; L. Sarac; O. Batukan Esen; S. Catirli Enar; A. Al Mulla; N. Bazargani; E. Al Hatou; F. Farook; W. Almahmeed; B. Salih; P. Clifford; N. Bowers; G. Veldtman; J. Kerr; L. Tellett; L. Hudsmith; P. Thompson; S. Thorne; S. Bowater; P. Nihoyannopoulos; R. Curry; L. Freeman; F. Schroeder; R. Wendler; S. Hammond; C. Talluto; D. Murphy; M. G. Perlroth; K. Chintala; P. Gupta; E. Pare; N. Khatri; N. Scott; D. De Faria-Yeh; A. B. Bhatt; S. Tsiaras; M. Gurvitz; C. Otto; J. Botti; J. Ting; W. R. Davidson

doi:10.1016/j.jacc.2016.07.750

Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry

Stefan Orwat, Gerhard Paul Diller, Iris M. van Hagen, Renate Schmidt, Daniel Tobler, Matthias Greutmann, Regina Jonkaitiene, Amro Elnagar, Mark R. Johnson, Roger Hall, Jolien W. Roos-Hesselink, Helmut Baumgartner, Roberto Ferrari, Aldo P. Maggioni, Ariane Marelli, Gary Webb, Harald Kaemmerer, Jana Popelova, Karen Sliwa, Luigi TavazziWilliam Anthony Parsonage, Joerg Stein, Uri Elkayam, Ulf Thilen, Werner Budts, Titia Ruys, Panos Vardas, Michel Komajda, Fausto Pinto, Angeles Alonso, David Wood, Nikolaos Maniadakis, Thierry Ferreira, Gérard Gracia, Cécile Laroche, Viviane Missiamenou, Charles Taylor, Marème Konte, Maryna Andarala, Emanuela Fiorucci, Elin Folkesson Lefrancq, Myriam Glémot, Patti Ann McNeill, Caroline Pommier, Myriam Lafay, A. Aquieri, H. Ruda Vega, M. Vázquez Blanco, K. Lust, N. Fagermo, H. Gabriel, E. Donhauser, Z. Gasimov, T. Jahangirov, I. Hasanova, J. De Backer, L. Demulier, M. de Hosson, M. Beckx, M. Moissens, T. Kovacevic-Preradovic, M. Kozic, M. Lovric, C. Vilas Freire, N. Chilingirova, P. Kratunkov, A. R. Montesclaros, E. Beaubien, E. Gordon, L. Walter, C. Lindsay, N. Wahab, Z. Vavera, A. El Nagar, H. H. Ebaid, W. A. El Sayed Makled, N. Taha, A. Dardier, M. Shabaan, Y. Elrakshy, K. Eltamawey, M. Gamal Abd-El Aziz, A. Saad, W. Aboleineen, Z. Ashour, K. Sorour, M. A.Meguid Mahdy, L. Iserin, M. Ladouceur, S. Cohen, B. Iung, D. Maisuradze, S. Mebus, U. Gembruch, C. Hammerstingl, W. M. Merz, C. Wald, R. Motz, A. Olsson, F. Berger, N. Nagdyman, A. Frogoudaki, M. Anastasiou-Nana, A. Temesvari, D. Kohalmi, H. Balint, B. Merkely, C. Liptai, M. Bowen, M. Cullen, P. Thornton, V. Husarova, A. Blatt, G. Elbaz-Greener, G. Moravsky, Z. Vered, A. Vazan Fuhrmann, A. Shotan, S. Goland, P. Festa, L. Ait Ali, G. Sinagra, I. Puggia, B. D.Agata Mottolese, M. G. Carmina, C. Romeo, R. Crepaz, V. Fesslova, A. Azzarelli, D. Baldi, F. Bovenzi, V. Donvito, E. Vasario, T. Todros, K. Niwa, A. Mussagaliyeva, D. Mekebekova, S. Sharipova, R. Zaliunas, J. Petrauskaite, L. Gumbiene, S. Jovanova, A. Cassar, M. Caruana, Y. Karamermer, J. M.J. Cornette, A. van Dijk, L. Bellersen, T. Duijnhouwer, C. De Groot, E. P.G. Pieper, C. van Oppen, P. Polak, E. Wajon, L. Wagenaar, M. Estensen, A. Lesniak-Sobelga, P. Podolec, S. Wisniowska-Smialek, A. Trybuch, P. Hoffman, A. Cichocka-Radwan, M. Lelonek, S. Sobczak, U. Faflik, A. Tomaszuk-Kazberuk, J. Przepiesc, M. Gil, K. Plaskota, O. Trojnarska, N. Guerra, L. de Sousa, V. Petrescu, C. Ginghina, R. Jurcut, I. Mircea Coman, I. Ravilevich Gaisin, L. Valeryevna Shilina, N. Sharashkina, O. Tkacheva, D. Ivanov, O. Irtyuga, L. Jovovic, K. Prokselj, M. Kozelj, C. Elliott, L. Galian-Gay, A. Pijuan-Domenech, M. T. Subirana-Domenech, P. Tornos, N. Murga, J. M. Oliver, P. Escribano-Subías, M. J. Ruiz-Cano, J. Delgado-Jiménez, E. Furenas, M. Dellborg, U. Thilén, M. Schwerzmann, J. Bouchardy, T. Rutz, L. Sarac, O. Batukan Esen, S. Catirli Enar, A. Al Mulla, N. Bazargani, E. Al Hatou, F. Farook, W. Almahmeed, B. Salih, P. Clifford, N. Bowers, G. Veldtman, J. Kerr, L. Tellett, L. Hudsmith, P. Thompson, S. Thorne, S. Bowater, P. Nihoyannopoulos, R. Curry, L. Freeman, F. Schroeder, R. Wendler, S. Hammond, C. Talluto, D. Murphy, M. G. Perlroth, K. Chintala, P. Gupta, E. Pare, N. Khatri, N. Scott, D. De Faria-Yeh, A. B. Bhatt, S. Tsiaras, M. Gurvitz, C. Otto, J. Botti, J. Ting, W. R. Davidson

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

94 Scopus citations

Abstract

Background Controversial results on maternal risk and fetal outcome have been reported in women with aortic stenosis (AS). Objectives The authors sought to investigate maternal and fetal outcomes in patients with AS in a large cohort. Methods The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective observational registry of women with structural heart disease, providing a uniquely large study population. Data of women with moderate (peak gradient 36 to 63 mm Hg) and severe AS (peak gradient ≥64 mm Hg) were analyzed. Results Of 2,966 pregnancies in ROPAC, the authors identified 96 women who had at least moderate AS (34 with severe AS). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women were hospitalized for cardiac reasons during pregnancy. This was significantly more common in severe AS compared with moderate AS (35.3% vs. 12.9%; p = 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed medically, except for 1 patient who was symptomatic before pregnancy and underwent balloon valvotomy. Children of patients with severe AS had a significantly higher percentage of low birth weight (35.0% vs. 6.0%; p = 0.006). Conclusions Mortality in pregnant women with AS, including those with severe AS, appears to be close to zero in the current era. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with high rates of hospitalization for cardiac reasons, although heart failure can nearly always be managed medically. The results highlight the importance of appropriate pre-conceptional patient evaluation and counseling.

Original language	English (US)
Pages (from-to)	1727-1737
Number of pages	11
Journal	Journal of the American College of Cardiology
Volume	68
Issue number	16
DOIs	https://doi.org/10.1016/j.jacc.2016.07.750
State	Published - Oct 18 2016

Keywords

fetal outcome
heart failure
maternal outcome
risk factors

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jacc.2016.07.750

Cite this

Orwat, S., Diller, G. P., van Hagen, I. M., Schmidt, R., Tobler, D., Greutmann, M., Jonkaitiene, R., Elnagar, A., Johnson, M. R., Hall, R., Roos-Hesselink, J. W., Baumgartner, H., Ferrari, R., Maggioni, A. P., Marelli, A., Webb, G., Kaemmerer, H., Popelova, J., Sliwa, K., ... Davidson, W. R. (2016). Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry. Journal of the American College of Cardiology, 68(16), 1727-1737. https://doi.org/10.1016/j.jacc.2016.07.750

Orwat, S, Diller, GP, van Hagen, IM, Schmidt, R, Tobler, D, Greutmann, M, Jonkaitiene, R, Elnagar, A, Johnson, MR, Hall, R, Roos-Hesselink, JW, Baumgartner, H, Ferrari, R, Maggioni, AP, Marelli, A, Webb, G, Kaemmerer, H, Popelova, J, Sliwa, K, Tavazzi, L, Parsonage, WA, Stein, J, Elkayam, U, Thilen, U, Budts, W, Ruys, T, Vardas, P, Komajda, M, Pinto, F, Alonso, A, Wood, D, Maniadakis, N, Ferreira, T, Gracia, G, Laroche, C, Missiamenou, V, Taylor, C, Konte, M, Andarala, M, Fiorucci, E, Lefrancq, EF, Glémot, M, McNeill, PA, Pommier, C, Lafay, M, Aquieri, A, Vega, HR, Blanco, MV, Lust, K, Fagermo, N, Gabriel, H, Donhauser, E, Gasimov, Z, Jahangirov, T, Hasanova, I, De Backer, J, Demulier, L, de Hosson, M, Beckx, M, Moissens, M, Kovacevic-Preradovic, T, Kozic, M, Lovric, M, Freire, CV, Chilingirova, N, Kratunkov, P, Montesclaros, AR, Beaubien, E, Gordon, E, Walter, L, Lindsay, C, Wahab, N, Vavera, Z, El Nagar, A, Ebaid, HH, El Sayed Makled, WA, Taha, N, Dardier, A, Shabaan, M, Elrakshy, Y, Eltamawey, K, Abd-El Aziz, MG, Saad, A, Aboleineen, W, Ashour, Z, Sorour, K, Mahdy, MAM, Iserin, L, Ladouceur, M, Cohen, S, Iung, B, Maisuradze, D, Mebus, S, Gembruch, U, Hammerstingl, C, Merz, WM, Wald, C, Motz, R, Olsson, A, Berger, F, Nagdyman, N, Frogoudaki, A, Anastasiou-Nana, M, Temesvari, A, Kohalmi, D, Balint, H, Merkely, B, Liptai, C, Bowen, M, Cullen, M, Thornton, P, Husarova, V, Blatt, A, Elbaz-Greener, G, Moravsky, G, Vered, Z, Fuhrmann, AV, Shotan, A, Goland, S, Festa, P, Ali, LA, Sinagra, G, Puggia, I, Mottolese, BDA, Carmina, MG, Romeo, C, Crepaz, R, Fesslova, V, Azzarelli, A, Baldi, D, Bovenzi, F, Donvito, V, Vasario, E, Todros, T, Niwa, K, Mussagaliyeva, A, Mekebekova, D, Sharipova, S, Zaliunas, R, Petrauskaite, J, Gumbiene, L, Jovanova, S, Cassar, A, Caruana, M, Karamermer, Y, Cornette, JMJ, van Dijk, A, Bellersen, L, Duijnhouwer, T, De Groot, C, Pieper, EPG, van Oppen, C, Polak, P, Wajon, E, Wagenaar, L, Estensen, M, Lesniak-Sobelga, A, Podolec, P, Wisniowska-Smialek, S, Trybuch, A, Hoffman, P, Cichocka-Radwan, A, Lelonek, M, Sobczak, S, Faflik, U, Tomaszuk-Kazberuk, A, Przepiesc, J, Gil, M, Plaskota, K, Trojnarska, O, Guerra, N, de Sousa, L, Petrescu, V, Ginghina, C, Jurcut, R, Coman, IM, Gaisin, IR, Shilina, LV, Sharashkina, N, Tkacheva, O, Ivanov, D, Irtyuga, O, Jovovic, L, Prokselj, K, Kozelj, M, Elliott, C, Galian-Gay, L, Pijuan-Domenech, A, Subirana-Domenech, MT, Tornos, P, Murga, N, Oliver, JM, Escribano-Subías, P, Ruiz-Cano, MJ, Delgado-Jiménez, J, Furenas, E, Dellborg, M, Thilén, U, Schwerzmann, M, Bouchardy, J, Rutz, T, Sarac, L, Esen, OB, Enar, SC, Al Mulla, A, Bazargani, N, Al Hatou, E, Farook, F, Almahmeed, W, Salih, B, Clifford, P, Bowers, N, Veldtman, G, Kerr, J, Tellett, L, Hudsmith, L, Thompson, P, Thorne, S, Bowater, S, Nihoyannopoulos, P, Curry, R, Freeman, L, Schroeder, F, Wendler, R, Hammond, S, Talluto, C, Murphy, D, Perlroth, MG, Chintala, K, Gupta, P, Pare, E, Khatri, N, Scott, N, De Faria-Yeh, D, Bhatt, AB, Tsiaras, S, Gurvitz, M, Otto, C, Botti, J, Ting, J & Davidson, WR 2016, 'Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry', Journal of the American College of Cardiology, vol. 68, no. 16, pp. 1727-1737. https://doi.org/10.1016/j.jacc.2016.07.750

@article{6a62ab782f774ae783661529ef26a837,

title = "Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry",

abstract = "Background Controversial results on maternal risk and fetal outcome have been reported in women with aortic stenosis (AS). Objectives The authors sought to investigate maternal and fetal outcomes in patients with AS in a large cohort. Methods The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective observational registry of women with structural heart disease, providing a uniquely large study population. Data of women with moderate (peak gradient 36 to 63 mm Hg) and severe AS (peak gradient ≥64 mm Hg) were analyzed. Results Of 2,966 pregnancies in ROPAC, the authors identified 96 women who had at least moderate AS (34 with severe AS). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women were hospitalized for cardiac reasons during pregnancy. This was significantly more common in severe AS compared with moderate AS (35.3% vs. 12.9%; p = 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed medically, except for 1 patient who was symptomatic before pregnancy and underwent balloon valvotomy. Children of patients with severe AS had a significantly higher percentage of low birth weight (35.0% vs. 6.0%; p = 0.006). Conclusions Mortality in pregnant women with AS, including those with severe AS, appears to be close to zero in the current era. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with high rates of hospitalization for cardiac reasons, although heart failure can nearly always be managed medically. The results highlight the importance of appropriate pre-conceptional patient evaluation and counseling.",

keywords = "fetal outcome, heart failure, maternal outcome, risk factors",

author = "Stefan Orwat and Diller, {Gerhard Paul} and {van Hagen}, {Iris M.} and Renate Schmidt and Daniel Tobler and Matthias Greutmann and Regina Jonkaitiene and Amro Elnagar and Johnson, {Mark R.} and Roger Hall and Roos-Hesselink, {Jolien W.} and Helmut Baumgartner and Roberto Ferrari and Maggioni, {Aldo P.} and Ariane Marelli and Gary Webb and Harald Kaemmerer and Jana Popelova and Karen Sliwa and Luigi Tavazzi and Parsonage, {William Anthony} and Joerg Stein and Uri Elkayam and Ulf Thilen and Werner Budts and Titia Ruys and Panos Vardas and Michel Komajda and Fausto Pinto and Angeles Alonso and David Wood and Nikolaos Maniadakis and Thierry Ferreira and G{\'e}rard Gracia and C{\'e}cile Laroche and Viviane Missiamenou and Charles Taylor and Mar{\`e}me Konte and Maryna Andarala and Emanuela Fiorucci and Lefrancq, {Elin Folkesson} and Myriam Gl{\'e}mot and McNeill, {Patti Ann} and Caroline Pommier and Myriam Lafay and A. Aquieri and Vega, {H. Ruda} and Blanco, {M. V{\'a}zquez} and K. Lust and N. Fagermo and H. Gabriel and E. Donhauser and Z. Gasimov and T. Jahangirov and I. Hasanova and {De Backer}, J. and L. Demulier and {de Hosson}, M. and M. Beckx and M. Moissens and T. Kovacevic-Preradovic and M. Kozic and M. Lovric and Freire, {C. Vilas} and N. Chilingirova and P. Kratunkov and Montesclaros, {A. R.} and E. Beaubien and E. Gordon and L. Walter and C. Lindsay and N. Wahab and Z. Vavera and {El Nagar}, A. and Ebaid, {H. H.} and {El Sayed Makled}, {W. A.} and N. Taha and A. Dardier and M. Shabaan and Y. Elrakshy and K. Eltamawey and {Abd-El Aziz}, {M. Gamal} and A. Saad and W. Aboleineen and Z. Ashour and K. Sorour and Mahdy, {M. A.Meguid} and L. Iserin and M. Ladouceur and S. Cohen and B. Iung and D. Maisuradze and S. Mebus and U. Gembruch and C. Hammerstingl and Merz, {W. M.} and C. Wald and R. Motz and A. Olsson and F. Berger and N. Nagdyman and A. Frogoudaki and M. Anastasiou-Nana and A. Temesvari and D. Kohalmi and H. Balint and B. Merkely and C. Liptai and M. Bowen and M. Cullen and P. Thornton and V. Husarova and A. Blatt and G. Elbaz-Greener and G. Moravsky and Z. Vered and Fuhrmann, {A. Vazan} and A. Shotan and S. Goland and P. Festa and Ali, {L. Ait} and G. Sinagra and I. Puggia and Mottolese, {B. D.Agata} and Carmina, {M. G.} and C. Romeo and R. Crepaz and V. Fesslova and A. Azzarelli and D. Baldi and F. Bovenzi and V. Donvito and E. Vasario and T. Todros and K. Niwa and A. Mussagaliyeva and D. Mekebekova and S. Sharipova and R. Zaliunas and J. Petrauskaite and L. Gumbiene and S. Jovanova and A. Cassar and M. Caruana and Y. Karamermer and Cornette, {J. M.J.} and {van Dijk}, A. and L. Bellersen and T. Duijnhouwer and {De Groot}, C. and Pieper, {E. P.G.} and {van Oppen}, C. and P. Polak and E. Wajon and L. Wagenaar and M. Estensen and A. Lesniak-Sobelga and P. Podolec and S. Wisniowska-Smialek and A. Trybuch and P. Hoffman and A. Cichocka-Radwan and M. Lelonek and S. Sobczak and U. Faflik and A. Tomaszuk-Kazberuk and J. Przepiesc and M. Gil and K. Plaskota and O. Trojnarska and N. Guerra and {de Sousa}, L. and V. Petrescu and C. Ginghina and R. Jurcut and Coman, {I. Mircea} and Gaisin, {I. Ravilevich} and Shilina, {L. Valeryevna} and N. Sharashkina and O. Tkacheva and D. Ivanov and O. Irtyuga and L. Jovovic and K. Prokselj and M. Kozelj and C. Elliott and L. Galian-Gay and A. Pijuan-Domenech and Subirana-Domenech, {M. T.} and P. Tornos and N. Murga and Oliver, {J. M.} and P. Escribano-Sub{\'i}as and Ruiz-Cano, {M. J.} and J. Delgado-Jim{\'e}nez and E. Furenas and M. Dellborg and U. Thil{\'e}n and M. Schwerzmann and J. Bouchardy and T. Rutz and L. Sarac and Esen, {O. Batukan} and Enar, {S. Catirli} and {Al Mulla}, A. and N. Bazargani and {Al Hatou}, E. and F. Farook and W. Almahmeed and B. Salih and P. Clifford and N. Bowers and G. Veldtman and J. Kerr and L. Tellett and L. Hudsmith and P. Thompson and S. Thorne and S. Bowater and P. Nihoyannopoulos and R. Curry and L. Freeman and F. Schroeder and R. Wendler and S. Hammond and C. Talluto and D. Murphy and Perlroth, {M. G.} and K. Chintala and P. Gupta and E. Pare and N. Khatri and N. Scott and {De Faria-Yeh}, D. and Bhatt, {A. B.} and S. Tsiaras and M. Gurvitz and C. Otto and J. Botti and J. Ting and Davidson, {W. R.}",

note = "Publisher Copyright: {\textcopyright} 2016 American College of Cardiology Foundation",

year = "2016",

month = oct,

day = "18",

doi = "10.1016/j.jacc.2016.07.750",

language = "English (US)",

volume = "68",

pages = "1727--1737",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "16",

}

TY - JOUR

T1 - Risk of Pregnancy in Moderate and Severe Aortic Stenosis

T2 - From the Multinational ROPAC Registry

AU - Orwat, Stefan

AU - Diller, Gerhard Paul

AU - van Hagen, Iris M.

AU - Schmidt, Renate

AU - Tobler, Daniel

AU - Greutmann, Matthias

AU - Jonkaitiene, Regina

AU - Elnagar, Amro

AU - Johnson, Mark R.

AU - Hall, Roger

AU - Roos-Hesselink, Jolien W.

AU - Baumgartner, Helmut

AU - Ferrari, Roberto

AU - Maggioni, Aldo P.

AU - Marelli, Ariane

AU - Webb, Gary

AU - Kaemmerer, Harald

AU - Popelova, Jana

AU - Sliwa, Karen

AU - Tavazzi, Luigi

AU - Parsonage, William Anthony

AU - Stein, Joerg

AU - Elkayam, Uri

AU - Thilen, Ulf

AU - Budts, Werner

AU - Ruys, Titia

AU - Vardas, Panos

AU - Komajda, Michel

AU - Pinto, Fausto

AU - Alonso, Angeles

AU - Wood, David

AU - Maniadakis, Nikolaos

AU - Ferreira, Thierry

AU - Gracia, Gérard

AU - Laroche, Cécile

AU - Missiamenou, Viviane

AU - Taylor, Charles

AU - Konte, Marème

AU - Andarala, Maryna

AU - Fiorucci, Emanuela

AU - Lefrancq, Elin Folkesson

AU - Glémot, Myriam

AU - McNeill, Patti Ann

AU - Pommier, Caroline

AU - Lafay, Myriam

AU - Aquieri, A.

AU - Vega, H. Ruda

AU - Blanco, M. Vázquez

AU - Lust, K.

AU - Fagermo, N.

AU - Gabriel, H.

AU - Donhauser, E.

AU - Gasimov, Z.

AU - Jahangirov, T.

AU - Hasanova, I.

AU - De Backer, J.

AU - Demulier, L.

AU - de Hosson, M.

AU - Beckx, M.

AU - Moissens, M.

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AU - Davidson, W. R.

PY - 2016/10/18

Y1 - 2016/10/18

N2 - Background Controversial results on maternal risk and fetal outcome have been reported in women with aortic stenosis (AS). Objectives The authors sought to investigate maternal and fetal outcomes in patients with AS in a large cohort. Methods The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective observational registry of women with structural heart disease, providing a uniquely large study population. Data of women with moderate (peak gradient 36 to 63 mm Hg) and severe AS (peak gradient ≥64 mm Hg) were analyzed. Results Of 2,966 pregnancies in ROPAC, the authors identified 96 women who had at least moderate AS (34 with severe AS). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women were hospitalized for cardiac reasons during pregnancy. This was significantly more common in severe AS compared with moderate AS (35.3% vs. 12.9%; p = 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed medically, except for 1 patient who was symptomatic before pregnancy and underwent balloon valvotomy. Children of patients with severe AS had a significantly higher percentage of low birth weight (35.0% vs. 6.0%; p = 0.006). Conclusions Mortality in pregnant women with AS, including those with severe AS, appears to be close to zero in the current era. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with high rates of hospitalization for cardiac reasons, although heart failure can nearly always be managed medically. The results highlight the importance of appropriate pre-conceptional patient evaluation and counseling.

AB - Background Controversial results on maternal risk and fetal outcome have been reported in women with aortic stenosis (AS). Objectives The authors sought to investigate maternal and fetal outcomes in patients with AS in a large cohort. Methods The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective observational registry of women with structural heart disease, providing a uniquely large study population. Data of women with moderate (peak gradient 36 to 63 mm Hg) and severe AS (peak gradient ≥64 mm Hg) were analyzed. Results Of 2,966 pregnancies in ROPAC, the authors identified 96 women who had at least moderate AS (34 with severe AS). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women were hospitalized for cardiac reasons during pregnancy. This was significantly more common in severe AS compared with moderate AS (35.3% vs. 12.9%; p = 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed medically, except for 1 patient who was symptomatic before pregnancy and underwent balloon valvotomy. Children of patients with severe AS had a significantly higher percentage of low birth weight (35.0% vs. 6.0%; p = 0.006). Conclusions Mortality in pregnant women with AS, including those with severe AS, appears to be close to zero in the current era. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with high rates of hospitalization for cardiac reasons, although heart failure can nearly always be managed medically. The results highlight the importance of appropriate pre-conceptional patient evaluation and counseling.

KW - fetal outcome

KW - heart failure

KW - maternal outcome

KW - risk factors

UR - http://www.scopus.com/inward/record.url?scp=84994493675&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994493675&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2016.07.750

DO - 10.1016/j.jacc.2016.07.750

M3 - Article

C2 - 27737738

AN - SCOPUS:84994493675

SN - 0735-1097

VL - 68

SP - 1727

EP - 1737

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 16

ER -