Procedural, pregnancy, and short-term outcomes after fetal aortic valvuloplasty

Neil D Patel; Stephen Nageotte; Frank F Ing; Aimee K Armstrong; Ramen Chmait; Jon A Detterich; Alberto Galindo; Helena Gardiner; Sofia Grinenco; Ulrike Herberg; Edgar Jaeggi; Shaine A Morris; Dick Oepkes; John M Simpson; Anita Moon-Grady; Jay D Pruetz

doi:10.1002/ccd.28846

Procedural, pregnancy, and short-term outcomes after fetal aortic valvuloplasty

Catheter Cardiovasc Interv. 2020 Sep 1;96(3):626-632. doi: 10.1002/ccd.28846. Epub 2020 Mar 26.

Authors

Neil D Patel¹, Stephen Nageotte², Frank F Ing³, Aimee K Armstrong⁴, Ramen Chmait⁵, Jon A Detterich^{1

6}, Alberto Galindo⁷, Helena Gardiner⁸, Sofia Grinenco⁹, Ulrike Herberg¹⁰, Edgar Jaeggi¹¹, Shaine A Morris¹², Dick Oepkes¹³, John M Simpson¹⁴, Anita Moon-Grady¹⁵, Jay D Pruetz¹

Affiliations

¹ Division of Pediatric Cardiology, Children's Hospital, University of Southern California Keck School of Medicine of USC, Los Angeles, California, USA.
² Division of Pediatric Cardiology, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St Louis, Missouri, USA.
³ Divison of Pediatric Cardiology, University of California Davis Children's Hospital, Sacramento, California, USA.
⁴ The Heart Center, Nationwide Children's Hospital, OH, Columbus, USA.
⁵ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
⁶ Department of Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
⁷ Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
⁸ The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics and Gynecology, McGovern Medical School, UTHealth, Houston, Texas, USA.
⁹ Hospital Italiano, Buenos Aires, Argentina.
¹⁰ Division of Pediatric Cardiology, Children's Hospital, University of Bonn, Germany.
¹¹ Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada.
¹² Division of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
¹³ Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
¹⁴ Evelina Children's Hospital, London, UK.
¹⁵ Division of Pediatric Cardiology, Department of Pediatrics and the Fetal Treatment Center at UCSF Benioff Children's Hospital, San Francisco, California, USA.

PMID: 32216096
DOI: 10.1002/ccd.28846

Abstract

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.

Keywords: aortic valve disease; congenital heart disease; pediatric intervention; pediatrics; percutaneous intervention.

Publication types

Multicenter Study

MeSH terms

Aortic Valve Stenosis / diagnostic imaging
Aortic Valve Stenosis / mortality
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / therapy*
Balloon Valvuloplasty* / adverse effects
Cardiac Catheterization* / adverse effects
Cardiac Catheterization* / mortality
Europe
Female
Fetal Death / etiology
Fetal Therapies* / adverse effects
Fetal Therapies* / mortality
Humans
Hypoplastic Left Heart Syndrome / mortality
Hypoplastic Left Heart Syndrome / prevention & control*
Live Birth
North America
Pregnancy
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
Treatment Outcome
Ultrasonography, Prenatal