Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, France (A.F., M.U., C.C.-N., J.K., E.B., J.A., Q.F., G.D., B.I., D.H.).
University of Paris, France (M.U., C.C.-N., Q.F., G.D., B.I.).
Circ Cardiovasc Interv. 2020 Dec;13(12):e009579. doi: 10.1161/CIRCINTERVENTIONS.120.009579. Epub 2020 Dec 2.
Transcatheter mitral valve implantation (TMVI) is emerging as an alternative to surgical mitral valve replacement in selected high-risk patients. Delaying definitive mechanical mitral valve replacement and the constraints of anticoagulation thanks to TMVI may be an attractive option in young women contemplating pregnancy and suffering from failure of mitral bioprosthesis or annuloplasty. The aim of the study was to evaluate the possibility, safety, and outcomes of pregnancy after TMVI in this population.
From 2013 to 2019, 12 young women contemplating pregnancy underwent transseptal valve-in-valve or valve-in-ring TMVI using the Edwards SAPIEN XT/3 valves and were prospectively followed up at 1 month, 6 months, 1 year, and yearly thereafter.
Mean age of the patients was 30±6 years. Bioprosthesis degeneration was observed in 7 cases and annuloplasty failure in 5. Three valve-in-ring patients required the implantation of a second valve, which led to an overall procedural success rate of 75%. One delayed left ventricular outflow tract obstruction required elective surgical mitral valve replacement. At 6 months/1 year, 83% of the patients were in New York Heart Association classes I/II. Mitral regurgitation was ≤2+ in all the cases and mean gradient was 7±2 mm Hg. Four patients could complete 6 full-term pregnancies. One symptomatic thrombosis occurred and resolved under aspirin and anticoagulation therapy. All others pregnancies were uneventful. Predelivery mean gradient was 11 mm Hg, and systolic pulmonary artery pressure was 32 mm Hg. There were 4 vaginal deliveries and 2 cesarians. Newborns were alive and healthy. At last follow-up, there was no death, and 3 patients required elective surgical mitral valve replacement at 6- to 54-month follow-up.
Our study suggests that, in young women, transseptal TMVI to treat failing bioprostheses may result in good short-term outcomes that allow uneventful pregnancies. The results are less favorable in women with failed annuloplasty rings.
经导管二尖瓣置换术（TMVI）在某些高危患者中作为二尖瓣置换术的替代方法正在出现。由于 TMVI，可以延迟明确的机械二尖瓣置换并避免抗凝，这对于考虑怀孕且患有二尖瓣生物瓣衰败或瓣环成形术失败的年轻女性来说可能是一个有吸引力的选择。本研究的目的是评估在该人群中经 TMVI 后怀孕的可能性、安全性和结局。
2013 年至 2019 年，12 名考虑怀孕的年轻女性接受了经房间隔的瓣膜内瓣或瓣环内 TMVI，使用 Edwards SAPIEN XT/3 瓣膜，并在术后 1 个月、6 个月、1 年以及之后每年进行前瞻性随访。
患者的平均年龄为 30±6 岁。7 例观察到生物瓣退化，5 例瓣环成形术失败。3 例瓣环内患者需要植入第二个瓣膜，整体手术成功率为 75%。1 例延迟性左心室流出道梗阻需要择期行二尖瓣置换术。术后 6 个月/1 年，83%的患者心功能分级为 I/II 级。所有患者的二尖瓣反流均≤2+，平均梯度为 7±2mmHg。4 例患者可完成 6 次足月妊娠。1 例出现症状性血栓形成，在阿司匹林和抗凝治疗下得到缓解。其他所有妊娠均无并发症。分娩前平均梯度为 11mmHg，收缩期肺动脉压为 32mmHg。有 4 例阴道分娩和 2 例剖宫产。新生儿均存活且健康。末次随访时无死亡，3 例患者在 6 至 54 个月随访时需要择期行二尖瓣置换术。
我们的研究表明，在年轻女性中，经房间隔 TMVI 治疗生物瓣衰败可能会带来良好的短期结局，使妊娠能够顺利进行。对于瓣环成形术失败的女性，结果则不太理想。
