Pregnancy does not accelerate biological valve degeneration

Background: Pregnancy in women with biological heart valve prosthesis might lead to a faster degeneration of the prosthesis. We analyzed the rate of prosthesis replacement and the outcome of pregnancies in women with biological valve prosthesis. Methods: Between 1976 and 2006, 100 female patients aged 18-40 years at time of the study, underwent a valve replacement with a bioprosthesis or a homograft. At a mean interval of 10.8 ± 8 years, 87 patients were evaluated by a questionnaire. Results: A biological prosthesis was implanted in 45 patients (52%), while 42 patients (48%) received a homograft. After valve replacement, 33 patients (38%) had a total of 56 pregnancies with a live-birth rate of 77% (n = 43). There were 9 (16%) miscarriages, 4 (7%) therapeutic abortions and no stillbirths. There was no maternal death, thromboembolic event or structural valve deterioration during pregnancy. Out of 87 patients, 31 (36%) required a valve re-replacement at a mean time of 9.5 ± 5 years. Neither age, valve type, valve position nor pregnancy were a risk factor for a valve re-replacement. The freedom from valve re-replacement at 5 and 10 years, was 96 ± 3% and 73 ± 9%, respectively for patients after a pregnancy compared to 93 ± 4% and 52 ± 10%, respectively for patients without a pregnancy (p = 0.2). Conclusions: Pregnancy does not accelerate the risk for replacement of a biological heart valve prosthesis. Pregnancy in women with biological heart valves can be carried out without increased morbidity related to the implanted valve.