PDF(Pubmed)
Abstract：
UNASSIGNED: To evaluate the ongoing debate concerning the choice of valve prosthesis for women requiring mitral valve replacement (MVR) and who wish to conceive. Bioprostheses are associated with risk of early structural valve deterioration. Mechanical prostheses require lifelong anticoagulation and carry maternal and fetal risks. Also, the optimal anticoagulation regimen during pregnancy after MVR remains unclear.
UNASSIGNED: A systematic review and meta-analysis was conducted of studies reporting on pregnancy after MVR. Valve- and anticoagulation-related maternal and fetal risks during pregnancy and 30 days\' postpartum were analyzed.
UNASSIGNED: Fifteen studies reporting 722 pregnancies were included. In total, 87.2% of pregnant women had a mechanical prosthesis and 12.5% a bioprosthesis. Maternal mortality risk was 1.33% (95% confidence interval [CI], 0.69-2.56), any hemorrhage risk 6.90% (95% CI, 3.70-12.88). Valve thrombosis risk was 4.71% (95% CI, 3.06-7.26) in patients with mechanical prostheses. 3.23% (95% CI, 1.34-7.75) of the patients with bioprostheses experienced early structural valve deterioration. Of these, the mortality was 40%. Pregnancy loss risk was 29.29% (95% CI, 19.74-43.47) with mechanical prostheses versus 13.50% (95% CI, 4.31-42.30) for bioprostheses. Switching to heparin during the first trimester demonstrated a bleeding risk of 7.78% (95% CI, 3.71-16.31) versus 4.08% (95% CI, 1.17-14.28) for women on oral anticoagulants throughout pregnancy and a valve thrombosis risk of 6.99% (95% CI, 2.08-23.51) versus 2.89% (95% CI, 1.40-5.94). Administration of anticoagulant dosages greater than 5 mg resulted in a risk of fetal adverse events of 74.24% (95% CI, 56.11-98.23) versus 8.85% (95% CI, 2.70-28.99) in ≤5 mg.
UNASSIGNED: A bioprosthesis seems the best option for women of childbearing age who are interested in future pregnancy after MVR. If mechanical valve replacement is preferred, the favorable anticoagulation regimen is continuous low-dose oral anticoagulants. Shared decision-making remains priority when choosing a prosthetic valve for young women.
UNASSIGNED: A systematic review and meta-analysis was conducted of studies reporting on pregnancy after MVR. Valve- and anticoagulation-related maternal and fetal risks during pregnancy and 30 days\' postpartum were analyzed.
UNASSIGNED: Fifteen studies reporting 722 pregnancies were included. In total, 87.2% of pregnant women had a mechanical prosthesis and 12.5% a bioprosthesis. Maternal mortality risk was 1.33% (95% confidence interval [CI], 0.69-2.56), any hemorrhage risk 6.90% (95% CI, 3.70-12.88). Valve thrombosis risk was 4.71% (95% CI, 3.06-7.26) in patients with mechanical prostheses. 3.23% (95% CI, 1.34-7.75) of the patients with bioprostheses experienced early structural valve deterioration. Of these, the mortality was 40%. Pregnancy loss risk was 29.29% (95% CI, 19.74-43.47) with mechanical prostheses versus 13.50% (95% CI, 4.31-42.30) for bioprostheses. Switching to heparin during the first trimester demonstrated a bleeding risk of 7.78% (95% CI, 3.71-16.31) versus 4.08% (95% CI, 1.17-14.28) for women on oral anticoagulants throughout pregnancy and a valve thrombosis risk of 6.99% (95% CI, 2.08-23.51) versus 2.89% (95% CI, 1.40-5.94). Administration of anticoagulant dosages greater than 5 mg resulted in a risk of fetal adverse events of 74.24% (95% CI, 56.11-98.23) versus 8.85% (95% CI, 2.70-28.99) in ≤5 mg.
UNASSIGNED: A bioprosthesis seems the best option for women of childbearing age who are interested in future pregnancy after MVR. If mechanical valve replacement is preferred, the favorable anticoagulation regimen is continuous low-dose oral anticoagulants. Shared decision-making remains priority when choosing a prosthetic valve for young women.
摘要：
■评估正在进行的关于需要二尖瓣置换术（MVR）的女性和希望怀孕的女性的瓣膜假体选择的辩论。生物假体与早期结构瓣膜恶化的风险相关。机械假体需要终身抗凝治疗，并具有母体和胎儿的风险。此外，MVR后妊娠期间的最佳抗凝方案尚不清楚.
■对报告MVR后妊娠的研究进行了系统评价和荟萃分析。分析妊娠和产后30天与瓣膜和抗凝相关的母婴风险。
■纳入了15项报告722例怀孕的研究。总的来说,87.2％的孕妇有机械假体和12.5％的生物假体。孕产妇死亡风险为1.33%(95%置信区间[CI]，0.69-2.56)，任何出血风险6.90%（95%CI，3.70-12.88）。机械假体患者的瓣膜血栓形成风险为4.71％（95％CI，3.06-7.26）。3.23%(95%CI,1.34-7.75)的生物假体患者出现早期结构性瓣膜恶化。其中,死亡率为40%。机械假体的妊娠丢失风险为29.29％（95％CI，19.74-43.47），而生物假体的妊娠丢失风险为13.50％（95％CI，4.31-42.30）。妊娠早期改用肝素治疗的妇女在整个妊娠期间的出血风险为7.78％（95％CI，3.71-16.31）和4.08％（95％CI，1.17-14.28），瓣膜血栓形成风险为6.99％（95％CI，2.08-23.51）和2.89％（95％CI，1.40-5.94）。服用大于5mg的抗凝剂剂量导致胎儿不良事件的风险为74.24％（95％CI，56.11-98.23），而≤5mg时的风险为8.85％（95％CI，2.70-28.99）。
生物假体似乎是对MVR后未来怀孕感兴趣的育龄妇女的最佳选择。如果首选机械瓣膜更换，有利的抗凝方案是连续低剂量口服抗凝剂.在为年轻女性选择人工瓣膜时，共同的决策仍然是优先事项。
■对报告MVR后妊娠的研究进行了系统评价和荟萃分析。分析妊娠和产后30天与瓣膜和抗凝相关的母婴风险。
■纳入了15项报告722例怀孕的研究。总的来说,87.2％的孕妇有机械假体和12.5％的生物假体。孕产妇死亡风险为1.33%(95%置信区间[CI]，0.69-2.56)，任何出血风险6.90%（95%CI，3.70-12.88）。机械假体患者的瓣膜血栓形成风险为4.71％（95％CI，3.06-7.26）。3.23%(95%CI,1.34-7.75)的生物假体患者出现早期结构性瓣膜恶化。其中,死亡率为40%。机械假体的妊娠丢失风险为29.29％（95％CI，19.74-43.47），而生物假体的妊娠丢失风险为13.50％（95％CI，4.31-42.30）。妊娠早期改用肝素治疗的妇女在整个妊娠期间的出血风险为7.78％（95％CI，3.71-16.31）和4.08％（95％CI，1.17-14.28），瓣膜血栓形成风险为6.99％（95％CI，2.08-23.51）和2.89％（95％CI，1.40-5.94）。服用大于5mg的抗凝剂剂量导致胎儿不良事件的风险为74.24％（95％CI，56.11-98.23），而≤5mg时的风险为8.85％（95％CI，2.70-28.99）。
生物假体似乎是对MVR后未来怀孕感兴趣的育龄妇女的最佳选择。如果首选机械瓣膜更换，有利的抗凝方案是连续低剂量口服抗凝剂.在为年轻女性选择人工瓣膜时，共同的决策仍然是优先事项。
