Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

Wagata, Maiko; Murakoshi, Takeshi; Ishii, Keisuke; Muromoto, Jin; Sasahara, Jun; Murotsuki, Jun

doi:10.1159/000442152

Cited by 13 publications

(9 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Kumar et al once reported two cases of presumed thermal injury to the cotwin's lower limb and scalp, respectively, which may be due to one of the 110°C RFA needle tines directly contacting the cotwin . Unlike the most widely used expandable needle electrodes, the MWA antenna is similar to the internally cooled electrodes in that each has one tip without tines, which makes them easy to manipulate and position in the target fetus . Thus, the MWA antenna will not contact the cotwin; this benefit may make MWA safer than RFA using expandable needle electrodes.…”

Section: Discussionmentioning

confidence: 99%

“…16 Unlike the most widely used expandable needle electrodes, the MWA antenna is similar to the internally cooled electrodes in that each has one tip without tines, which makes them easy to manipulate and position in the target fetus. 6,7,21 Thus, the MWA antenna will not contact the cotwin; this benefit may make MWA safer than RFA using expandable needle electrodes. due to its decreased susceptibility to the heat-sink effect.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Forty‐five consecutive cases of complicated monochorionic multiple pregnancy treated with microwave ablation: A single‐center experience

et al. 2019

View full text Add to dashboard Cite

Objective To describe our preliminary experience in the application of microwave ablation for selective fetal reduction in complicated monochorionic multiple pregnancies. Methods In this prospective study, 45 consecutive complicated monochorionic multiple pregnancies that underwent microwave ablation for selective fetal reduction from July 2015 to February 2017 were analyzed from the first case onward. All patients were managed at the Peking University Third Hospital in Beijing, China. Results There were 45 cases (twins in 40 and triplets in five) treated by microwave ablation. The median gestational age at surgery was 21.3 weeks (range, 15.9‐25.7 wk), with a mean total ablation time of 8.5 ± 4.2 (7.2‐9.7) minutes. There were 12 (26.7%) cases of postprocedural fetal loss. Thirty‐three women delivered alive at a median gestational age of 37.6 weeks (range, 28.6‐40.4 wk). There were no neonatal deaths in our cohort, and the overall survival rate was 73.3% (33/45). Preterm premature rupture of membranes occurred in 9 (20.0%) cases with a median of 7.0 weeks (range, 0.9‐16.3 wk) after the surgery. None of the surviving cotwins had evidence of thermal injury or neurological abnormalities. Conclusion Microwave ablation appears to be a safe and effective method for selective feticide in complicated monochorionic pregnancies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Forty‐five consecutive cases of complicated monochorionic multiple pregnancy treated with microwave ablation: A single‐center experience

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The overall survival rate was 85%, and the mean gestational age at delivery was 37 weeks for the pump twins. The other study also reported good outcomes of RFA treatment for TRAP sequence, with a survival rate of 88% [57]. Although reports of RFA treatment for TRAP sequence are limited, RFA is thought to be a useful treatment option for TRAP sequence after 15 weeks' gestation.…”

Section: Radiofrequency Ablationmentioning

confidence: 88%

“…Lee et al [55] reported the North American Fetal Therapy Network registry data of RFA treatment for TRAP sequence and showed the 80% survival rate. Two studies of RFA for TRAP sequence were performed in Japan [56,57]. We reported the outcomes of 40 cases of TRAP sequence treated with RFA, which is the largest single-center study [56].…”

Section: Radiofrequency Ablationmentioning

confidence: 99%

Fetal therapies as standard prenatal care in Japan

Sago

Wada

2020

Obstet Gynecol Sci

View full text Add to dashboard Cite

With recent advances in fetal medicine, various attempts have been made to save fetuses facing perinatal death or devastating consequences despite optimal management after birth. The concept of the fetus as a patient has been established through the application of in utero treatments. This paper reviews fetal therapies in order to highlight the role of perinatal medicine as standard prenatal care. Fetal therapies consist of medical therapy, percutaneous ultrasound-guided surgery, fetoscopic surgery, and open fetal surgery. In the 1980s, with advances in ultrasound imaging, percutaneous ultrasound-guided surgeries such as vesicoamniotic shunting for lower urinary tract obstruction and thoracoamniotic shunting (TAS) for fetal hydrothorax (FHT) were started. In the 1990s, fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS) was introduced, and later, a fetoscopic approach for congenital diaphragmatic hernia was also established. The revival of open fetal surgery, introduced in the 1980s by pediatric surgeons, began in the 2010s after a successful clinical study for myelomeningocele. Although many fetal therapies are still considered experimental, some have proven effective, such as FLS for TTTS, TAS for primary FHT, and radiofrequency ablation (RFA) for twin reversed arterial perfusion (TRAP) sequence. These three fetal therapies have been approved for coverage by Japan National Health Insurance as a result of clinical studies performed in Japan. FLS for TTTS, TAS for primary FHT, and RFA for TRAP sequence have become standard prenatal care approaches in Japan. These three minimally invasive fetal therapies will help improve the perinatal outcomes of fetuses with these disorders.

show abstract

“…The primary indications for RFA are TRAPs and other lethal foetal anomalies [14]. After RFA, the overall survival rate of the co-twin in TRAPs is determined to be at 75.0-92% [8][9][10][15][16][17][18][19], but it varies in other anomalies, ranging 33-92.3% [8,13,15]. RFA is also recommended for sIUGR in which laser may not be a desirable choice for large vessel anastomosis [5,20,21].…”

Section: Introductionmentioning

confidence: 99%

Influence of indications on perinatal outcomes after radio frequency ablation in complicated monochorionic pregnancies: a retrospective cohort study

Wang

Zhou

Wang

et al. 2021

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background Radiofrequency ablation (RFA) is recommended to prevent potential neurological injury or intrauterine foetal death (IUFD) of the co-twin(s) in complicated monochorionic (MC) pregnancies. However, the impacts of various indications on the pregnancy outcome following RFA remain unclear. This study aimed to determine how the indications influence the perinatal outcomes in complicated MC pregnancies undergoing radiofrequency ablation. Methods This was a retrospective cohort study performed in a single centre. All consecutive MC pregnancies treated with RFA between July 2011 and July 2019 were included. The adverse perinatal outcomes and the survival rate were analysed based on various indications. The continuous variables with and without normal distribution were compared between the groups using Student’s t-test and Mann–Whitney U test, respectively, and for categorical variables, Chi-square and Fisher’s exact tests were used. P < 0.05 indicated a significant difference. Results We performed 272 RFA procedures in 268 complicated MC pregnancies, including 60 selective intrauterine growth restriction (sIUGR), 64 twin–twin transfusion syndrome (TTTS), 12 twin reversed arterial perfusion sequence (TRAPs), 66 foetal anomaly and 66 elective foetal reduction (EFR) cases. The overall survival rate of the co-twin was 201/272 (73.9%). The overall technical successful rate was determined at 201/263 (76.7%). The IUFD rate in the co-twin was 20/272 (7.4%). The TTTS group had recorded the lowest survival rate (37/64, 57. 8%), and the survival rate was significantly correlated with Quintero stages (P = 0.029). Moreover, the sIUGR III subgroup had a lower survival rate compared with sIUGR II (55.6%, versus 84.3%). The subgroup of foetal anomaly of gastroschisis or exomphalos had the highest IUFD rate (4/10, 40%), followed by sIUGR III (2/9, 22.2%) and dichorionic triamniotic (DCTA) subgroup (8/46, 17.9%). In EFR group, eight IUFD cases were all coming from the DCTA subgroup and received RFA before 17 weeks. Conclusions The perinatal outcome of RFA was correlated with the indications, with the lowest survival rate in TTTS IV and the highest IUFD incidence in abdominal wall defect followed by sIUGR III. Elective RFA after 17 weeks may prevent IUFD in DCTA pregnancies.

show abstract

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

Cited by 13 publications

References 34 publications

Forty‐five consecutive cases of complicated monochorionic multiple pregnancy treated with microwave ablation: A single‐center experience

Forty‐five consecutive cases of complicated monochorionic multiple pregnancy treated with microwave ablation: A single‐center experience

Fetal therapies as standard prenatal care in Japan

Influence of indications on perinatal outcomes after radio frequency ablation in complicated monochorionic pregnancies: a retrospective cohort study

Contact Info

Product

Resources

About