Background:
Late cardiac outcomes in women with aortic stenosis (AS) who have undergone pregnancy have not been well defined.

Methods:
We examined 51 consecutive women with congenital AS who underwent 70 pregnancies. Late cardiac events (pulmonary edema, cardiac arrhythmia, cardiac death, cardiac interventions >1 year since baseline evaluation) were the outcome of interest. The frequency of late cardiac events in the postpregnant group were compared to age- and lesion-matched women with congenital AS who have never been pregnant.

Results:
During the follow-up period (6+4 years), 43% of women underwent cardiac interventions which comprised all late cardiac events. Independent baseline predictors of late cardiac events were (1) moderate or severe AS (hazard ratio=4.5, P=.045) and (2) New York Functional Class II (hazard ratio=4.6, P=.014). When outcomes in 26 women from the postpregnant group were compared to 26 age- and lesion-matched women who have never been pregnant, the postpregnant group had a higher late cardiac event rate than the never-pregnant group (31% vs 0%, P=.021).

Conclusion:
Women with moderate or severe AS and symptomatic during pregnancy are at high likelihood of requiring cardiac interventions late after pregnancy. Women with congenital AS who have undergone pregnancy have a higher frequency of late cardiac events compared to those who have never been pregnant. Late cardiac outcomes after pregnancy should be considered in the counseling of women with AS who are contemplating pregnancy (Figs 1 and 2).

Figure 1: Late cardiac outcomes in postpregnant group. (Reprinted from Tzemos N, Silversides CK, Colman JM, et al. Late cardiac outcomes after pregnancy in women with congenital aortic stenosis. Am Heart J. 2009;157:474-480, with permission from Elsevier.)

Figure 2: Late cardiac outcomes in matched women from postpregnant and never-pregnant groups. (Reprinted from Tzemos N, Silversides CK, Colman JM, et al. Late cardiac outcomes after pregnancy in women with congenital aortic stenosis. Am Heart J. 2009;157:474-480, with permission from Elsevier.)