Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis

Abstract

Symptomatic degenerative prosthetic aortic valve stenosis during pregnancy represents a significant risk to both mother and fetus, and until recently, surgical aortic valve replacement (SAVR) during pregnancy was often the only choice for women opting to continue pregnancy. However, symptomatic severe stenosis in a pregnant woman with a degenerated full aortic root Freestyle stentless bioprosthesis (FSB) and reimplanted coronary arteries presents additional complexities that require an alternative surgical approach. In this case report, we describe the first successful transcatheter aortic valve replacement (TAVR) in SAVR for a severely stenotic degenerative FSB in a pregnant woman and subsequent delivery of a healthy infant several months later. TAVR in SAVR of a severely stenotic aortic FSB should be considered as a surgical option in symptomatic pregnant women. Short-term and long-term implications for future pregnancy should be discussed by a multidisciplinary team and with the patient. K E Y W O R D Saortic stenosis, pregnancy, TAVR in SAVR

Repeat Pregnancy after Prior Aortic Valve-in-Valve Replacement: A Cautionary Tale

“…However, outcomes of repeat pregnancy in women with prior TAVR or TAVR in SAVR are unreported at this time, and concerns have been raised regarding subsequent pregnancies in these women. [10][11][12][13] We describe the course of pregnancy, maternal, and fetal outcomes in a woman with prior TAVR in SAVR, and we reaffirm our recommendation to assemble a multidisciplinary team in the management of patients with prior TAVR or TAVR in SAVR who wish to conceive or who become pregnant.…”

“…4,5,[11][12][13] As of this writing, there have only been five reports of young women receiving TAVR or TAVR in SAVR while pregnant, one with severe native aortic valve stenosis and four with TAVR in SAVR. [6][7][8][9][10] It is unknown how women with a previous TAVR of severe aortic stenosis or TAVR in SAVR will tolerate subsequent pregnancies, due to lack of publications regarding short-and long-term maternal and fetal outcomes of repeat pregnancy after TAVR. Our case represents the first report of subsequent pregnancy outcome in a woman with prior TAVR in SAVR.…”

“…She was counseled for appropriate contraception and advised to delay future pregnancies until the full impact of the recent TAVR in SAVR in the short-and long-term was fully evaluated. 10 Seven months later, at the time of presentation with current pregnancy, the patient had no cardiac symptoms or noncardiac symptoms other than minor vaginal spotting prior to the appointment. Repeat echocardiogram showed stability of the TAVR bioprosthesis hemodynamics with no significant elevation of gradient or perivalvular regurgitation compared to baseline post-procedure values.…”

“…Previously, individual case reports have described five women who received either TAVR for a severely stenotic aortic valve or TAVR in SAVR for symptomatic stenosis during pregnancy. [6][7][8][9][10] Following this procedure, all women had uncomplicated post-operative recovery, uneventful pregnancies, and successfully delivered healthy infants. However, outcomes of repeat pregnancy in women with prior TAVR or TAVR in SAVR are unreported at this time, and concerns have been raised regarding subsequent pregnancies in these women.…”

Management of Valvular Disease During Pregnancy: Evolving Role of Percutaneous Treatment

“…Therefore, despite the small amount of data during pregnancy, the valve-in-valve procedure already seems to be the optimal therapy for symptomatic pregnant women with severe bioprosthesis dysfunction in aortic and other anatomical locations. [ 31 – 34 ] However, there are no data regarding the safety and durability of such a procedure in young women. Moreover, due to the high prevalence of small aortic root anatomies in young women, the risk of prosthesis–patient mismatch in case of valve-in-valve implantation should be carefully evaluated.…”