P1628Outcome of pregnancy in patients with cardiovascular disease, experience in a centre

Abstract

Introduction: Maternal mortality in Europe is very low, nevertheless among women with cardiovascular disease it can be as high as 1/100 pregnancies. With the increasing congenital heart disease (CHD) population arriving to childbearing age, including complex lesions, cardiologist would frequently face the challenge to manage these patients (pt). It is thereafter of paramount importance to create specialised units and to share the experience for better understanding and care of this population. Purpose(s): We present the experience of our centre on the management of pregnancy in patients with cardiovascular disease. Method(s): We have retrospectively collected the data of pregnancies followed in our Unit from 1999 to 2016. Since 2007 a multidisciplinary team take care of these pt. We classified the pt according to the WHO maternal risk score (Figure 1), and we analysed the type of cardiovascular disease, method of delivery, rate of abortion and maternal and foetal complications, during pregnancy and on the following 6 months Results: We have followed 100 pregnancies in 88 women (mean age 31.1 years). Maternal risk groups (WHO classification) distribution was as follow: 40% group IV, 12% group III, 24% group II and 24% group I. The most relevant complication were: 8pt developed heart failure, 1 pt needed valvular replacement immediately after delivery; 1pt was listed for lung transplant and other for urgent heart transplant. 2 pt died during pregnancy (2%), both had severe PAH: one had cardiorespiratory arrest during the therapeutic abortion on week 8 and the other needed support with V-V ECMO, dying on week 23, after caesarean on week 22. Foetal mortality was 3%, due to obstetric complications. Conclusion(s): Maternal mortality during pregnancy in our group is higher than describe on the European registry, although the percentage of pt on WHO group IV is significantly higher in our series (41% vs 4%). Complication and mortality are directly related with the maternal risk group. All pt with cardiovascular disease on childbearing age should have access to preconception advice. Pregnancy should be precluded on high risk patients, in case of pregnancy the follow up and management must be done on a specialised unit, due to the high mortality and morbidity risk and the necessity of advanced therapies (ECMO support, urgent heart surgery, transplantation).