Abstract 3367: Pregnancy and Long Term Outcomes in Women With Congenital Aortic Stenosis
Introduction Whether pregnancy affects late outcomes in pregnant women with congenital aortic stenosis (AS) has not been systematically examined. The objective of this study was to examine the late outcomes of women with AS who had undergone pregnancy compared to those who had not.
Methods We prospectively examined 80 consecutive women with congenital AS followed at our centre. Fifty women who underwent 80 pregnancies (mean age 27±12 yrs during index pregnancy) comprised the pregnancy group. A group of 30 women with congenital aortic stenosis (mean age 28±6 yrs at first clinic visit) who have not been pregnant comprised the control group. Baseline echocardiography was performed to assess aortic valve gradient, aortic valve area, and LV systolic function. Significant AS was defined by peak aortic gradient ≥ 36 mmHg and the presence of aortic valve area <1.5 cm2. Cardiac outcome was defined as the need for aortic valve replacement (AVR) or cardiac death.
Results The proportion of women in the pregnancy group with a median age ≥ 28 yrs was higher than that of controls (64% vs 30%, p=0.003, respectively). Ten percent of women in both groups have one or more coronary risk factor. The frequency of significant AS was higher in the pregnancy group compared to controls (68% and 40%, p=0.014). No women had significant left ventricular systolic dysfunction. The mean follow up period was similar in both groups (study group 5±4 vs. control group 4±3 yrs; p=NS). Overall, 20 women underwent AVR during follow-up. There were no cardiac deaths. AVR for symptomatic deterioration occurred more commonly in women who had undergone a pregnancy compared to women who had not (36% vs 7%; p<0.02). On multivariate Cox regression analysis, predictors of AVR included:
age≥28 years in combination with prior pregnancy (p=0.02) and
significant AS at baseline (p=0.01).
Conclusion Women with moderate or severe AS and those undergoing pregnancy at an older age are more likely to require AVR in follow-up. These factors should be incorporated into pre pregnancy counseling of women with AS who are contemplating pregnancy.