Indications, procedural profile, and outcomes of cardiac interventions during pregnancy: interim insights from the NPAC-India study registry

Background

Cardiac disease complicating pregnancy remains a major contributor to maternal morbidity in low- and middle-income countries, largely driven by rheumatic valvular lesions. However, real-world multicentre data on the indications and outcomes of cardiac interventions during pregnancy are limited.

Purpose

To evaluate the indications, procedural profile, and outcomes of cardiac interventions during pregnancy in the ongoing NPAC-India prospective registry.

Methods

NPAC-India is an ongoing multicentre prospective registry across 56 sites in India enrolling pregnant women with structural or acquired heart disease. We analysed participants who underwent cardiac intervention during pregnancy between August 2024 and January 2026. Indications included severe symptoms despite optimal medical therapy or severe disease with anticipated clinical deterioration during pregnancy. Functional class, gestational age at intervention, procedural success, and pregnancy outcomes were assessed.

Results

Among 5,200 enrolled participants, cardiac intervention during pregnancy was performed in 102 women (1.9%) across 21 participating sites. The mean age was 27.2 ± 4.8 years, and the mean gestational age at intervention was 25.4 ± 6.0 weeks. Most women were significantly symptomatic antenatally, with 53.9% (55/102) in NYHA class III or IV.

Balloon mitral valvotomy was the predominant intervention (83/102, 82.4%), followed by balloon pulmonary valvotomy and permanent pacemaker implantation (5 each, 4.9%). Other procedures included percutaneous coronary intervention with stenting (3/102, 2.9%), aortic coarctation intervention (2/102, 2.0%), and miscellaneous procedures (3/102, 2.9%).

Most procedures were performed as emergency (33/102, 32.4%) or urgent (33/102, 32.4%), while 36/102 (35.3%) were planned. Complete procedural success was achieved in 91 (89.2%), with partial success in 9 (8.8%) and failure in 2 (1.9%). There were 2 maternal deaths (1.9%).

Of the 102 pregnancies, 22 are yet to deliver, 5 underwent medical termination, and 1 had a spontaneous abortion. Among the remaining 74 pregnancies, there were 72 live births and 2 stillbirths.

Conclusion

In this large prospective multicentre Indian registry, cardiac interventions during pregnancy were required in a small but high-risk subset. Interventions were most often performed in the second trimester and were associated with high procedural success and favourable perinatal outcomes despite significant baseline maternal symptom burden. These findings support the feasibility and relative safety of carefully selected, timely cardiac interventions during pregnancy in experienced centres, underscoring the importance of multidisciplinary evaluation and early referral in symptomatic women.