Late cardiac outcomes after pregnancy in women with congenital aortic stenosis
Received 15 August 2008; accepted 26 October 2008.
Background
Late cardiac outcomes in women with aortic stenosis (AS) who have undergone pregnancy have not been well defined.
Methods
We examined 51 consecutive women with congenital AS who underwent 70 pregnancies. Late cardiac events (pulmonary edema, cardiac arrhythmia, cardiac death, cardiac interventions >1 year since baseline evaluation) were the outcome of interest. The frequency of late cardiac events in the postpregnant group were compared to age- and lesion-matched women with congenital AS who have never been pregnant.
Results
During the follow-up period (6 + 4 years), 43% of women underwent cardiac interventions which comprised all late cardiac events. Independent baseline predictors of late cardiac events were (1) moderate or severe AS (hazard ratio = 4.5, P = .045) and (2) New York Functional Class II (hazard ratio = 4.6, P = .014). When outcomes in 26 women from the postpregnant group were compared to 26 age- and lesion-matched women who have never been pregnant, the postpregnant group had a higher late cardiac event rate than the never-pregnant group (31% vs 0%, P = .021).
Conclusion
Women with moderate or severe AS and symptomatic during pregnancy are at high likelihood of requiring cardiac interventions late after pregnancy. Women with congenital AS who have undergone pregnancy have a higher frequency of late cardiac events compared to those who have never been pregnant. Late cardiac outcomes after pregnancy should be considered in the counseling of women with AS who are contemplating pregnancy.
aUniversity of Toronto Pregnancy and Heart Disease Research Program and Toronto Congenital Cardiac Centre for Adults, Toronto General and Mount Sinai Hospitals, Toronto, Ontario, Canada
bDivision of Cardiology, Sir M B Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
cPhiladelphia Adult Congenital Heart Centre, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
dDivision of Cardiology (SCS), University of Western Ontario, London, Ontario, Canada
Reprint requests: Samuel Siu, MD, C6-005, University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5.
ABSTRACT