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Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study
Ultrasound in obstetrics & gynecology, 2018-08, Vol.52 (2), p.221-229
Kovacevic, A.
Öhman, A.
Tulzer, G.
Herberg, U.
Dangel, J.
Carvalho, J. S.
Fesslova, V.
Jicinska, H.
Sarkola, T.
Pedroza, C.
Averiss, I. E.
Mellander, M.
Gardiner, H. M.
Bartrons, Joaquim
Bulock, Frances
Shebani, Suhair
Ann Clur, Sally
Daehnert, Ingo
Di Salvo, Giovanni
Heying, Ruth
Gewillig, Marc
Grijseels, Els
Koopmann, Laurens
Makikallio, Kaarin
Tekay, Aydin
Leskinen, Markku
Manning, Nicky
Archer, Nick
Oberhoffer, Renate
Romeo, Cristina
Ejvind Sørensen, Keld
Richens, Trevor
Schmidt, Klaus
Seale, Anna
Jowett, Victoria
Tissot, Cecile
Tomek, Viktor
Uhlemann, Frank
Vejlstrup, Niels
Weil, Jochen
Koleśnik, Adam
Dębska, Marzena
Włoch, Agata
Dryżek, Paweł
Chojnicki, Maciej
2018
Volltextzugriff (PDF)
Details
Autor(en) / Beteiligte
Kovacevic, A.
Öhman, A.
Tulzer, G.
Herberg, U.
Dangel, J.
Carvalho, J. S.
Fesslova, V.
Jicinska, H.
Sarkola, T.
Pedroza, C.
Averiss, I. E.
Mellander, M.
Gardiner, H. M.
Bartrons, Joaquim
Bulock, Frances
Shebani, Suhair
Ann Clur, Sally
Daehnert, Ingo
Di Salvo, Giovanni
Heying, Ruth
Gewillig, Marc
Grijseels, Els
Koopmann, Laurens
Makikallio, Kaarin
Tekay, Aydin
Leskinen, Markku
Manning, Nicky
Archer, Nick
Oberhoffer, Renate
Romeo, Cristina
Ejvind Sørensen, Keld
Richens, Trevor
Schmidt, Klaus
Seale, Anna
Jowett, Victoria
Tissot, Cecile
Tomek, Viktor
Uhlemann, Frank
Vejlstrup, Niels
Weil, Jochen
Koleśnik, Adam
Dębska, Marzena
Włoch, Agata
Dryżek, Paweł
Chojnicki, Maciej
Titel
Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study
Ist Teil von
Ultrasound in obstetrics & gynecology, 2018-08, Vol.52 (2), p.221-229
Ort / Verlag
Chichester, UK: John Wiley & Sons, Ltd
Erscheinungsjahr
2018
Quelle
Wiley Online Library - AutoHoldings Journals
Beschreibungen/Notizen
ABSTRACT Objective Fetal aortic stenosis may progress to hypoplastic left heart syndrome. Fetal valvuloplasty (FV) has been proposed to improve left heart hemodynamics and maintain biventricular (BV) circulation. The aim of this study was to assess FV efficacy by comparing survival and postnatal circulation between fetuses that underwent FV and those that did not. Methods This was a retrospective multicenter study of fetuses with aortic stenosis that underwent FV between 2005 and 2012, compared with contemporaneously enrolled natural history (NH) cases sharing similar characteristics at presentation but not undergoing FV. Main outcome measures were overall survival, BV‐circulation survival and survival after birth. Secondary outcomes were hemodynamic change and left heart growth. A propensity score model was created including 54/67 FV and 60/147 NH fetuses. Analyses were performed using logistic, Cox or linear regression models with inverse probability of treatment weighting (IPTW) restricted to fetuses with a propensity score of 0.14–0.9, to create a final cohort for analysis of 42 FV and 29 NH cases. Results FV was technically successful in 59/67 fetuses at a median age of 26 (21–34) weeks. There were 7/72 (10%) procedure‐related losses, and 22/53 (42%) FV babies were delivered at < 37 weeks. IPTW demonstrated improved survival of liveborn infants following FV (hazard ratio, 0.38; 95% CI, 0.23–0.64; P = 0.0001), after adjusting for circulation and postnatal surgical center. Similar proportions had BV circulation (36% for the FV cohort and 38% for the NH cohort) and survival was similar between final circulations. Successful FV cases showed improved hemodynamic response and less deterioration of left heart growth compared with NH cases (P ≤ 0.01). Conclusions We report improvements in fetal hemodynamics and preservation of left heart growth following successful FV compared with NH. While the proportion of those achieving a BV circulation outcome was similar in both cohorts, FV survivors showed improved survival independent of final circulation to 10 years' follow‐up. However, FV is associated with a 10% procedure‐related loss and increased prematurity compared with the NH cohort, and therefore the risk‐to‐benefit ratio remains uncertain. We recommend a carefully designed trial incorporating appropriate and integrated fetal and postnatal management strategies to account for center‐specific practices, so that the benefits achieved by fetal therapy vs surgical strategy can be demonstrated clearly. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Sprache
Englisch
Identifikatoren
ISSN: 0960-7692
eISSN: 1469-0705
DOI: 10.1002/uog.18913
Titel-ID: cdi_proquest_miscellaneous_1947099765
Format
–
Schlagworte
Aortic stenosis
,
Aortic Valve Stenosis - embryology
,
Aortic Valve Stenosis - physiopathology
,
Aortic Valve Stenosis - surgery
,
Babies
,
Balloon Valvuloplasty
,
Blood circulation
,
Clinical outcomes
,
Coronary Circulation
,
Disease Progression
,
Female
,
Fetal Heart - diagnostic imaging
,
fetal therapy
,
fetus
,
Fetuses
,
Gestational Age
,
Heart
,
Heart surgery
,
Hemodynamics
,
Humans
,
Hypoplastic Left Heart Syndrome - embryology
,
Hypoplastic Left Heart Syndrome - physiopathology
,
Hypoplastic Left Heart Syndrome - prevention & control
,
Infant, Newborn
,
Infants
,
Norwood procedure
,
Pregnancy
,
Pregnancy Outcome
,
Prenatal Care
,
Preservation
,
Propensity Score
,
Regression analysis
,
Regression models
,
Retrospective Studies
,
Risk Assessment
,
Statistical analysis
,
Stenosis
,
Surgery
,
Survival
,
Survival Rate
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