Maternal, Valvular and Foetal Outcomes of Pregnancy Following Aortic Valve Replacement

Objectives: To investigate the optimal valve substitute for young women requiring aortic valve replacement (AVR), allowing improved future valve-related outcomes for mother and foetus during pregnancy. Methods: A systematic search was performed for publications between 1998 and 2025 reporting women experiencing pregnancy after AVR with a pulmonary autograft (Ross-procedure), homograft, bioprosthesis (xenograft), or mechanical valve. Pooled proportions were calculated to determine maternal, valvular and foetal outcomes during pregnancy using generalized linear mixed models. Results: Thirteen studies reporting 356 pregnancies in 251 women (pooled mean age at pregnancy 29.1 ± 4.8 years) after AVR with a pulmonary autograft (70 women, 119 pregnancies), homograft (73 women, 99 pregnancies), bioprosthesis (37 women, 50 pregnancies), or mechanical valve (71 women, 88 pregnancies) were included. During pregnancy, valve-related reintervention in women with a bioprosthesis was 2.7% (95% CI, 0.4-16.9) at 5.1 ± 2.5 years after AVR. This was not observed in women with pulmonary autografts (7.7 ± 4.2 years after AVR) and homografts (4.1 ± 3.3 years after AVR). Reintervention for valve thrombosis (4.9% [95% CI, 1.6-14.0]) and maternal death (1.1% [95% CI, 0.2-7.6]) occurred only in women with mechanical valves (8.1 ± 4.5 years after AVR). Pooled probability of liveborn delivery was 71.7% (95% CI, 59.2-81.6) in women with a mechanical valve, compared to 90.6% (95% CI, 72.4-97.3), 92.3% (95% CI, 56.0-99.1), and 82.9% (95% CI, 53.3-95.4) in women with an autograft, homograft, and bioprosthesis respectively. Conclusions: Maternal mortality and valve thrombosis during pregnancy occurred only in women with mechanical valves. Although no statistical comparisons were made, pregnancies in women with pulmonary autograft, homograft or bioprosthesis showed acceptable maternal and foetal outcomes. These descriptive findings provide foundations for further investigation of tissue-valve function before, during and after pregnancy, aiming for more support of current guidelines.