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Procedural, pregnancy, and short‐term outcomes after fetal aortic valvuloplasty
Author(s) -
Patel Neil D.,
Nageotte Stephen,
Ing Frank F.,
Armstrong Aimee K.,
Chmait Ramen,
Detterich Jon A.,
Galindo Alberto,
Gardiner Helena,
Grinenco Sofia,
Herberg Ulrike,
Jaeggi Edgar,
Morris Shaine A.,
Oepkes Dick,
Simpson John M.,
MoonGrady Anita,
Pruetz Jay D.
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28846
Subject(s) - medicine , aortic valvuloplasty , hypoplastic left heart syndrome , pericardial effusion , odds ratio , cardiology , gestational age , pregnancy , surgery , aortic valve stenosis , stenosis , heart disease , biology , genetics
Objectives We aimed to evaluate the effect of technical aspects of fetal aortic valvuloplasty (FAV) on procedural risks and pregnancy outcomes. Background FAV is performed in cases of severe mid‐gestation aortic stenosis with the goal of preventing hypoplastic left heart syndrome (HLHS). Methods The International Fetal Cardiac Intervention Registry was queried for fetuses who underwent FAV from 2002 to 2018, excluding one high‐volume center. Results The 108 fetuses had an attempted cardiac puncture (mean gestational age [GA] 26.1 ± 3.3 weeks). 83.3% of attempted interventions were technically successful (increased forward flow/new aortic insufficiency). The interventional cannula was larger than 19 g in 70.4%. More than one cardiac puncture was performed in 25.0%. Intraprocedural complications occurred in 48.1%, including bradycardia (34.1%), pericardial (22.2%) or pleural effusion (2.7%) requiring drainage, and balloon rupture (5.6%). Death within 48 hr occurred in 16.7% of fetuses. Of the 81 patients born alive, 59 were discharged home, 34 of whom had biventricular circulation. More than one cardiac puncture was associated with higher complication rates ( p < .001). Larger cannula size was associated with higher pericardial effusion rates ( p = .044). On multivariate analysis, technical success (odds ratio [OR] = 10.9, 95% confidence interval [CI] = 2.2–53.5, p = .003) and later GA at intervention (OR = 1.5, 95% CI = 1.2–1.9, p = .002) were associated with increased odds of live birth. Conclusions FAV is an often successful but high‐risk procedure. Multiple cardiac punctures are associated with increased complication and fetal mortality rates. Later GA at intervention and technical success were independently associated with increased odds of live birth. However, performing the procedure later in gestation may miss the window to prevent progression to HLHS.