Author + information
- Received May 27, 2016
- Revision received July 7, 2016
- Accepted July 12, 2016
- Published online October 18, 2016.
- Stefan Orwat, MDa,
- Gerhard-Paul Diller, MD, PhD, MSca,
- Iris M. van Hagen, MDb,
- Renate Schmidt, MDa,
- Daniel Tobler, MDc,
- Matthias Greutmann, MDd,
- Regina Jonkaitiene, MDe,
- Amro Elnagar, MDf,
- Mark R. Johnson, MD, PhDg,
- Roger Hall, MDh,
- Jolien W. Roos-Hesselink, MD, PhDb,i,
- Helmut Baumgartner, MDa,∗ (, )
- ROPAC Investigators
- aDivision of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
- bDepartment of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- cAdult Congenital Heart Disease Clinic, University Hospital, Basel, Switzerland
- dAdult Congenital Heart Disease Program, University Heart Center, Zurich, Switzerland
- eDepartment of Cardiology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
- fDepartment of Cardiology, Benha University Hospital, Benha, Egypt
- gDepartment of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, United Kingdom
- hDepartment of Cardiology, Norwich Medical School, University of East Anglia, United Kingdom
- iEURObservational Research Programme, European Society of Cardiology
- ↵∗Reprint requests and correspondence:
Prof. Helmut Baumgartner, Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
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.
The ROPAC is a registry within the EURObservational Research Programme of the European Society of Cardiology (EORP). Since the start of EORP, the following companies have supported the program: Abbott Vascular Int. (2011 to 2014), Amgen (2009 to 2018), AstraZeneca (2014 to 2017), Bayer Pharma AG (2009 to 2018), Boehringer Ingelheim (2009 to 2016), Boston Scientific (2009 to 2012), the Bristol-Myers Squibb and Pfizer Alliance (2011 to 2016), the Alliance Daiichi-Sankyo Europe GmbH and Eli Lilly and Company (2011 to 2017), Gedeon Richter Plc. (2014 to 2017), Menarini Int. Op. (2009 to 2012), MSD-Merck & Co. (2011 to 2014), Novartis Pharma AG (2014 to 2017), ResMed (2014 to 2016), Sanofi (2009 to 2011), and SERVIER (2009 to 2018). The companies that support EORP were not involved in any part of the study or this report. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 27, 2016.
- Revision received July 7, 2016.
- Accepted July 12, 2016.
- American College of Cardiology Foundation