P314 - IMPACT OF PREGNANCY ON AORTA DILATION, AORTIC VALVE DISEASE PROGRESSION, AND CLINICAL OUTCOMES IN WOMEN WITH BICUSPID AORTIC VALVE

Background: Bicuspid aortic valve (BAV) is associated with an increased risk of aortopathy, aortic valve dysfunction and adverse events. Pregnancy is associated with disease progression and serious complications if the impairment is severe. However, its effect on aortic and BAV disease progression in women with minimal to mild impairment remains unknown. This study aimed to evaluate the impact of pregnancy on the progression of aortopathy, aortic valve disease, and clinical outcomes in women with BAV and minimal to mild impairment.

METHODS AND RESULTS: Thirty-four women (mean age 29±6 years) with BAV and minimal to mild impairment were retrospectively matched: 18 without pregnancy (non-pregnant group: NP) and 16 with at least one pregnancy (pregnant group: P). All patients underwent at least two Doppler echocardiograms to assess the progression of aortic disease (sinus of Valsalva, sinotubular junction, and ascending aorta), aortic valve disease (mean pressure gradient (MG), and indexed aortic valve area (AVAi)), and indexed stroke volume (SVi). Annualized progression of aortic and aortic valve disease was calculated between baseline and last follow up.
During a mean follow-up of 6.3±3.6 years in the NP group and 7.2±3.2 years in the P group, pregnancy was not associated with faster progression of aortic diameters: sinus of Valsalva (0.01 [-0.02-0.04] vs. 0.02 [0.00-0.07] cm/year), sinotubular junction (0.04 [0.02-0.04] vs. 0.02 [-0.02-0.04] cm/year), and ascending aorta (0.01 [0.00-0.05] vs. 0.05 [0.00-0.07] cm/year); all p>0.19. Similarly, no effect of pregnancy on MG progression was observed (0.22 [-0.00-0.48] vs. 0.09 [-0.02-0.49] mmHg/year, p=0.52). However, AVAi decreased more rapidly in the NP group (-0.01[-0.03-0.01] vs. P: -0.003[-0.01-0.02] cm2/m2/year; p< 0.001). SVi increased significantly in the P group (NP: 0.01[-1.77-0.43] vs. P: 1.34[0.49-1.75] ml/m2/year; p=0.001), although the mean follow-up between delivery and the last echocardiogram was 4.7±3.5 years. Moreover, no significant difference in the progression of aortic regurgitation was observed, nor in adverse clinical events between the two groups during a follow-up of 12±4 years; all p>0.35.

Conclusion: In women with BAV and minimal to mild impairment, pregnancy was not associated with progression of aortic dilation, BAV disease, or long-term adverse cardiovascular clinical events. Further studies with larger sample sizes are needed to confirm these findings.