With severe diseases of the aortic valve, choosing a new heart valve is especially difficult for young women who want to become pregnant. A new Swedish registry study by Karolinska Institutet shows that biological aortic valves lead to better pregnancy and birth outcomes, even though they often require additional surgery than mechanical valves. The study was published in the Journal of the American College of Cardiology (JACC).
In cases of severe aortic valve disease, even young women may need surgery to replace the valve. There are two main options. Although mechanical valves are very durable, they require lifelong treatment with blood-thinning drugs and can pose risks to both the woman and the fetus during pregnancy. Bioprosthetic valves, on the other hand, do not require the same type of blood thinners, but they wear out quickly and may require another surgery in the future.
In the current study, researchers analyzed Swedish women aged 18 to 40 who underwent aortic valve replacement between 1997 and 2024. A total of 251 women were included, of whom 93 received bioprosthetic valves and 158 received mechanical valves. Data were obtained from national registries and tracked over time.
Help provide better information for joint decision-making
About half of the women who received the biological valve gave birth to at least one child during the follow-up period, compared with less than one in 10 of the women who received the mechanical valve. Women with bioprosthetic valves had better long-term cardiovascular outcomes despite higher reintervention rates.
Our results demonstrate that biologic valves are a reasonable option for women planning pregnancy, even if the risk of future reoperation must be recognized. We hope that our results can support better shared decision-making between doctors and patients. ”
Ruixin Lu, PhD student, Department of Molecular Medicine and Surgery, Karolinska Institutet
“We are encouraged that many women with biological aortic valves are able to experience pregnancy and childbirth. At the same time, we know that many of these young women will later require revision surgery as their valves wear out over time. In ongoing research, we are investigating how we can improve the evaluation and treatment before the next heart surgery,” says Ulrik Sartipi, cardiac surgeon at Karolinska University Hospital and adjunct professor at Karolinska University’s Department of Molecular Medicine and Surgery. Institute.
The researchers emphasize that valve selection should always be tailored to each patient’s individual circumstances and life plans.
This study is a national observational study based on the Swedish Health Data Registry. The study was carried out in collaboration with Karolinska Institutet and Karolinska University Hospital. Funding was provided by the Swedish Heart and Lung Foundation, the Stockholm Region, and foundations associated with the Karolinska Institutet, among others.
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Reference magazines:
Lu, R. Others. (2026). Aortic valve replacement in women of reproductive age. jack. DOI: 10.1016/j.jacc.2026.05.024. https://www.jacc.org/doi/10.1016/j.jacc.2026.05.024
