J 2018

Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study

KOVACEVIC, A., A. OHMAN, G. TULZER, U. HERBERG, J. DANGEL et. al.

Základní údaje

Originální název

Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study

Autoři

KOVACEVIC, A. (826 Velká Británie a Severní Irsko), A. OHMAN (752 Švédsko), G. TULZER (40 Rakousko), U. HERBERG (276 Německo), J. DANGEL (616 Polsko), J.S. CARVALHO (826 Velká Británie a Severní Irsko), V. FESSLOVA (380 Itálie), Hana JIČÍNSKÁ (203 Česká republika, domácí), T. SARKOLA (246 Finsko), C. PEDROZA (840 Spojené státy), I.E. AVERISS (840 Spojené státy), M. MELLANDER (752 Švédsko) a H.M. GARDINER (840 Spojené státy, garant)

Vydání

ULTRASOUND IN OBSTETRICS & GYNECOLOGY, HOBOKEN, WILEY-BLACKWELL, 2018, 0960-7692

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30214 Obstetrics and gynaecology

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 5.595

Kód RIV

RIV/00216224:14110/18:00104181

Organizační jednotka

Lékařská fakulta

DOI

UT WoS

000440665400013

Klíčová slova anglicky

aortic stenosis; fetal therapy; fetus; Norwood procedure

Štítky

Příznaky

Mezinárodní význam, Recenzováno
Změněno: 10. 2. 2019 13:05, Soňa Böhmová

Anotace

V originále

Objective Fetal aortic stenosis may progress to hypoplastic left heart syndrome. Fetal valvuloplasty (FV) has been proposed to improve left heart hemo-dynamics 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 (C) 2017 ISUOG. Published by John Wiley & Sons Ltd.