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Challenges of the Transcatheter Approach to Mitral Valve Replacement in Women Contemplating Pregnancy.

Young women with mitral valve disease face a dilemma when selecting a mitral prosthesis, and there is no perfect solution. In general, tissue prostheses are preferable in women who plan to become pregnant but degenerate more quickly in young patients necessitating a repeat intervention.1 Some may experience structural valve deterioration even before their first pregnancy, and at the time of a second operation, a mechanical valve is frequently advised.2 If they have babies before structural valve deterioration and die at reoperation, they leave children without a biological mother. The necessary anticoagulation that accompanies a mechanical valve poses significant maternal and fetal risks during the markedly prothrombotic state of pregnancy.3 Whichever anticoagulant strategy is selected, risks include maternal hemorrhage, valve thrombosis, miscarriage, and fetal demise.3 Registries report that women with mechanical heart valves have only a 58% chance of having an uncomplicated pregnancy with a live birth.3,4