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

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.

Basic information

Original name

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

Authors

KOVACEVIC, A. (826 United Kingdom of Great Britain and Northern Ireland), A. OHMAN (752 Sweden), G. TULZER (40 Austria), U. HERBERG (276 Germany), J. DANGEL (616 Poland), J.S. CARVALHO (826 United Kingdom of Great Britain and Northern Ireland), V. FESSLOVA (380 Italy), Hana JIČÍNSKÁ (203 Czech Republic, belonging to the institution), T. SARKOLA (246 Finland), C. PEDROZA (840 United States of America), I.E. AVERISS (840 United States of America), M. MELLANDER (752 Sweden) and H.M. GARDINER (840 United States of America, guarantor)

Edition

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

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30214 Obstetrics and gynaecology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 5.595

RIV identification code

RIV/00216224:14110/18:00104181

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1002/uog.18913

UT WoS

000440665400013

Keywords in English

aortic stenosis; fetal therapy; fetus; Norwood procedure

Abstract

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.

Citovat

KOVACEVIC, A., A. OHMAN, G. TULZER, U. HERBERG, J. DANGEL, J.S. CARVALHO, V. FESSLOVA, Hana JIČÍNSKÁ, T. SARKOLA, C. PEDROZA, I.E. AVERISS, M. MELLANDER and H.M. GARDINER. Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY. HOBOKEN: WILEY-BLACKWELL, 2018, vol. 52, No 2, p. 221-229. ISSN 0960-7692. Available from: https://dx.doi.org/10.1002/uog.18913.

@article{1454976,
   author = {Kovacevic, A. and Ohman, A. and Tulzer, G. and Herberg, U. and Dangel, J. and Carvalho, J.S. and Fesslova, V. and Jičínská, Hana and Sarkola, T. and Pedroza, C. and Averiss, I.E. and Mellander, M. and Gardiner, H.M.},
   article_location = {HOBOKEN},
   article_number = {2},
   doi = {http://dx.doi.org/10.1002/uog.18913},
   keywords = {aortic stenosis; fetal therapy; fetus; Norwood procedure},
   language = {eng},
   issn = {0960-7692},
   journal = {ULTRASOUND IN OBSTETRICS & GYNECOLOGY},
   title = {Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study},
   volume = {52},
   year = {2018}
}

TY  - JOUR
ID  - 1454976
AU  - Kovacevic, A. - Ohman, A. - Tulzer, G. - Herberg, U. - Dangel, J. - Carvalho, J.S. - Fesslova, V. - Jičínská, Hana - Sarkola, T. - Pedroza, C. - Averiss, I.E. - Mellander, M. - Gardiner, H.M.
PY  - 2018
TI  - Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study
JF  - ULTRASOUND IN OBSTETRICS & GYNECOLOGY
VL  - 52
IS  - 2
SP  - 221-229
EP  - 221-229
PB  - WILEY-BLACKWELL
SN  - 09607692
KW  - aortic stenosis
KW  - fetal therapy
KW  - fetus
KW  - Norwood procedure
N2  - 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.
ER  -

KOVACEVIC, A., A. OHMAN, G. TULZER, U. HERBERG, J. DANGEL, J.S. CARVALHO, V. FESSLOVA, Hana JIČÍNSKÁ, T. SARKOLA, C. PEDROZA, I.E. AVERISS, M. MELLANDER and H.M. GARDINER. Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study. \textit{ULTRASOUND IN OBSTETRICS \&{}amp; GYNECOLOGY}. HOBOKEN: WILEY-BLACKWELL, 2018, vol.~52, No~2, p.~221-229. ISSN~0960-7692. Available from: https://dx.doi.org/10.1002/uog.18913.

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