Fetal Aortic Valvuloplasty: Experience and Results of Two Tertiary Centers in Spain

Abstract

Objective: Fetal aortic valvuloplasty (FAV) may avoid progression of critical aortic stenosis (CAS) to hypoplastic left ventricle, improving the options for biventricular circulation (BVC). We describe the results of FAV in 2 referral centers in Spain. Methods: We analyzed all FAVs performed in the period 2007-2015. The selection of candidates, the technique, and postnatal management were made following an agreed protocol. A descriptive analysis of survival, type of circulation after birth, and complications was made, considering all deaths in the first 48 h after FAV as FAV-related. Results: FAV was performed in 28 fetuses at a median gestational age (GA) of 23 weeks (range, 20-32). FAV was technically successful in 22 (78.6%), of whom 11 were born alive and with intention to treat. Eight (72.7%) resulted in BVC and 3 (27.3%) in univentricular circulation. The rate of FAV-related deaths was 32%. These patients underwent FAV earlier than live-born fetuses (median GA at FAV 22 weeks [range, 20.0-25.0] vs. 24.5 weeks [range, 21.0-32.0], respectively, p = 0.031). Conclusions: A significant proportion of fetuses with CAS who undergo technically successful FAV have BVC postnatally. However, FAV implies a high risk of fetal death, which highly depends on the GA at which this intervention is required.

Fetal aortic valvuloplasty to prevent progression to hypoplastic left heart syndrome in utero

“…Technical success has been reported to range from 77 to 94% (Friedman et al, ; Galindo et al, ; Kovacevic et al, ), with higher success rates at centers with greater experience. Similarly, although fetal demise rates of ~10% were previously described (Freud et al, ; Kovacevic et al, ; Moon‐Grady et al, ), a large center recently reported that their rate has decreased to <5% (Friedman et al, ).…”

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“…The Boston group's results were slightly better than those from 2 European studies showing 88% and 74% technical success rates, and biventricular repair rates of 36% and 78%, respectively . Given the lack of randomized trials in this field, it is still unclear whether the outcomes of intervention are better than the natural history of the disease and offset the increased risk of fetal death due to the procedure (6%–36%) .…”

“…46 The Boston group's results were slightly better than those from 2 European studies showing 88% and 74% technical success rates, and biventricular repair rates of 36% and 78%, respectively. 47,48 Given the lack of randomized trials in this field, it is still unclear whether the outcomes of intervention are better than the natural history of the disease and offset the increased risk of fetal death due to the procedure (6%-36%). 44,47,48 Indeed, Gardiner et al recently published a large "natural history" cohort that showed that approximately 1 in 3 fetuses fulfilling the criteria for intra-uterine intervention still had a biventricular postnatal circulation, even without the procedure.…”

“…47,48 Given the lack of randomized trials in this field, it is still unclear whether the outcomes of intervention are better than the natural history of the disease and offset the increased risk of fetal death due to the procedure (6%-36%). 44,47,48 Indeed, Gardiner et al recently published a large "natural history" cohort that showed that approximately 1 in 3 fetuses fulfilling the criteria for intra-uterine intervention still had a biventricular postnatal circulation, even without the procedure. 49 As such, fetal aortic valvuloplasty remains experimental, and further refinement of selection criteria or a randomized controlled trial comparing intervention to expectant management with standardized postnatal care are urgently needed.…”

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“…Estos tumores pueden ser únicos o múltiples, tener tamaños y morfologías diversas, y originarse del miocardio, endocardio o pericardio. [1][2][3] A pesar de que la mayor parte de estos tumores son benignos (97%), dependiendo de su tamaño y ubicación será la posibilidad de obstruir los conductos de salida o las válvulas aurículo-ventriculares, con la subsecuente insuficiencia cardiaca congestiva, arritmias, derrame pericárdico e hídrops.…”