# Valve replacement during pregnancy: literature review including new data from the Registry Of Pregnancy And Cardiac disease III **Authors:** Johanna A van der Zande, Sergii Siromakha, Puck N J Peters, Ghada Youssef, Laura Galian-Gay, Magalie Ladouceur, Gretchen Wells, Johanna J M Takkenberg, Kevin M Veen, Karishma P Ramlakhan, Roger Hall, Mark R Johnson, Jolien W Roos-Hesselink, R Ferrari, R Ferrari, A Alonso, J Bax, C Blomström-Lundqvist, S Gielen, P Lancellotti, A P Maggioni, N Maniadakis, F Pinto, F Ruschitzka, L Tavazzi, P Vardas, F Weidinger, U Zeymer, A Budaj, N Dagres, N Danchin, V Delgado, J Emberson, O Friberg, C P Gale, G Heyndrickx, B Iung, S James, A P Kappetein, A P Maggioni, N Maniadakis, K V Nagy, G Parati, A-S Petronio, M Pietila, E Prescott, F Ruschitzka, F Van de Werf, F Weidinger, U Zeymer, C P Gale, B Beleslin, A Budaj, O Chioncel, N Dagres, N Danchin, J Emberson, D Erlinge, M Glikson, A Gray, M Kayikcioglu, A P Maggioni, K V Nagy, A Nedoshivin, A-P Petronio, J W Roos-Hesselink, L Wallentin, U Zeymer, D Adlam, A L P Caforio, D Capodanno, M Dweck, D Erlinge, M Glikson, J Hausleiter, B Iung, M Kayikcioglu, P Ludman, L Lund, A P Maggioni, S Matskeplishvili, B Meder, K V Nagy, A Nedoshivin, D Neglia, A A Pasquet, J W Roos-Hesselink, F J Rossello, S M Shaheen, A Torbica, Jolien Roos-Hesselink, Roger Hall, William Parsonage, Werner Budts, Julie de Backer, Jasmin Grewal, Ariane Marelli, Guillaume Jondeau, Mark Johnson, Catherine Otto, Karen Sliwa, Aldo Maggioni, K Vardanyan, A Melkonyan, H Lachikyan, K Hakobyan, M Mazmanian, Yerevan: H Hayrapetyan, A Tavaracyan, H Poghosyan, R Hovhannisyan, S Sahakyan, S Martirosyan, J Harris, A Pasquet, M Morissens, T Besse-Hammer, B Dumoulin, J De Backer, L Campens, L Demulier, M De Hosson, W Budts, A Van de Bruaene, A Rampelberg, E Troost, L Roggen, P De Meester, J C Mwita, E Tefera, L Kontle, A Marelli, I Malhamé, J Grewal, M Janzen, P A Román Rubio, R Vasallo Peraza, G Vázquez Hernández, J E Pérez Torga, Y Gil Jiménez, M Meluzá Martín, R Almaleh, G Youssef, K Sorour, S Abebe, D Mekonnen, C Fekadu, D Yadeta, S Dupuis-Girod, L Delagrange, M Richardson, L Ghesquiere, O Domanski, M Gonzalez Estevez, Y Ould Hamoud, S Gautier, L Marsili, L Bal-Theoleyre, S Palazzolo, M Ladouceur, G Jondeau, A Bourgeois Moine, L Eliaou, O Milleron, M Tchitchinadze, Y Dulac, C Karsenty, N Souletie, F Bajanca, C Rickers, S Blankenberg, C Sinning, C Magnussen, E Zengin, G Mueller, R Schnabel, Y Von Kodolitsch, R Kozlik-Feldmann, H Baumgartner, R Schmidt, A Hellige, A Rietkötter, M Spartalis, A A Frogoudaki, A Arvanitaki, A Baroutidou, G Giannakoulas, C Karvounis, J P Gnanaraj, A P Steaphen, T Ethirajan, K Kannan, V Subramanian, A Surendran, J Gnanasekaran, V Natarajalingam, S Balasubramani, H Ali Farhan, I F Yaseen, E Mariucci, C Ciuca, F Marchi, G Benedetti, M Baroni, P Festa, A Parlanti, G Scognamiglio, F Fusco, B Sarubbi, M Merlo, B D'Agata Mottolese, C Carriere, G Sinagra, M Bobbo, F Ramani, F M Comoglio, R Bordese, A Pagano, N Montali, V Donvito, C A Remolif, F Petey, B Bouma, S Chamuleau, D Robbers-Visser, T Konings, H Dronkert, D Segers, R Van Kimmenade, H Van, Der Zwaan, G Tjalling Sieswerda, A Evers, T Schaap, K Bano, H Yasmeen, K Amir, N Patel, P Akhter, R Khan, A Shakeel, S Mahar, S Habib, M Lelonek, P Hoffman, M Lipczynska, L De Sousa, V Ferreira, T Mano, M Selas, R Cruz Ferreira, E Shlyakhto, O Irtyuga, G Sefieva, K Malikov, T Pervunina, U Shadrina, A Kinsara, D Galzerano, H Al Sergani, W Kurdi, N Kholaif, O Vriz, A Alhamshari, A Alsaigh, O Ahmad, S Alzaher, B Alamro, K Sliwa, F Jakoet-Bassier, L Galian-Gay, A Pijuan-Domenech, B Miranda-Barrio, B Gordon, E Furenäs, J Hlebowicz, F Wedlund, E Nagy, E Mattsson, M Majczuk Sennstrom, P Sörensson, C Christersson, A Lutvica, B Jönelid, T Achter, K Junus, H Gärdesten Wall, M Andreasson, D Tobler, J Bouchardy, F Brand, C Blanche, J Bouchardy, T Rutz, F Brand, U Canpolat, Y Z Sener, N Ozer, E Ayduk Gövdeli, Z Bugra, B Umman, P Karaca Özer, D Baykiz, D Mutlu, H Yalman, B Kilickiran Avci, S Catirli Enar, O Batukan Esen, D Oksen, V Lazoryshynets, S Siromakha, Y Davydova, A Limanska, I Zinovchyk, V Kravchenko, B Kravchuk, O Kravets, N Volkova, O Mazur, O Beregovyi, B T Salih, W A R Al Mahmeed, S Wani, F S Mohamed Farook, G Al Mansoori, S Prakash, R Afifi, D Milewicz, A Cecchi, G Wells, D Sparks, W Wagner, C Bigelow, L Colicchia, T Jentink, M Loichinger, R Saxena, W Wunderlich, C Longtin, P Klopper, R Gobar, J Chou, K Campbell, R Elder, D Halpern, A Hausvater, H Reynolds, N Bhalla, A Small, J Feinberg, P Panday, J Awerbach, J Porche, S Stack, L Mcgrath, A Khan, E Pare, P Woods, C Broberg, K Gibbins, K Brookfield, M Al-Sadawi, A Cove, N Mann PMC · DOI: 10.1093/ejcts/ezaf180 · European Journal of Cardio-Thoracic Surgery · 2025-06-20 ## TL;DR Heart valve replacement during pregnancy is risky, with high maternal and fetal death rates, especially when replacing existing prosthetic valves. ## Contribution The study provides new data from the ROPAC III registry and identifies predictors for maternal and fetal mortality. ## Key findings - Valve replacement in the first trimester and acute malfunctioning of a prosthetic valve are predictors for maternal mortality. - Replacement of an existing prosthetic valve is a predictor for fetal mortality. - Maternal and fetal death rates were 9% and 34%, respectively, with all maternal deaths occurring in mitral valve replacements. ## Abstract Heart valve replacement during pregnancy is sometimes unavoidable, and the need for anticoagulation further complicates these procedures. Our study describes cases of valve replacement in pregnancy enrolled in the Registry Of Pregnancy And Cardiac disease (ROPAC) III and gives an overview of the published literature. We performed a systematic review with new data from the ROPAC III and data available in the literature. ROPAC III is a global, prospective, observational registry that included pregnant women with 1 or more prosthetic valves between January 2018 and April 2023. Electronic databases were searched for studies enrolling pregnant women who underwent valve replacement during pregnancy with a fetus in utero. The primary outcomes were maternal and fetal death. Mixed-effect logistic regression models were used to identify predictors for maternal and fetal mortality. A valve replacement was performed in 11 pregnancies. The mother and fetus died in 1 case, and in 2 cases, reversible postoperative complications occurred. We found 74 cases in the literature and calculated an overall maternal and fetal death rate of 9% and 34%, respectively. All maternal deaths occurred in women with a replacement of a prosthetic valve in mitral position. We found valve replacement in the 1st trimester (OR 10.0) and acute malfunctioning of an existing prosthetic valve (OR 19.7) as predictors for maternal mortality, and replacement of an existing prosthetic valve (OR 4.8) as predictor for fetal mortality. Valve replacement during pregnancy carries a high maternal and fetal death, especially in women who need a replacement of an existing prosthetic valve. Pregnancy in women with cardiac disease poses an elevated risk of maternal and fetal morbidity and mortality, especially to those who are not able to sufficiently adapt to the haemodynamic challenges of pregnancy [1, 2]. ## Linked entities - **Diseases:** cardiac disease (MONDO:0005267) ## Full-text entities - **Diseases:** maternal and fetal death (MESH:D005313), Cardiac disease (MESH:D006331), deaths (MESH:D003643) - **Species:** Homo sapiens (human, species) [taxon 9606] ## Full text _Full body text omitted from this summary view._ Fetch the complete paper as Markdown: https://tomesphere.com/paper/PMC12245401/full.md ## Figures 2 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12245401/full.md ## References 24 references — full list in the complete paper: https://tomesphere.com/paper/PMC12245401/full.md --- Source: https://tomesphere.com/paper/PMC12245401