International Fetal Cardiac Intervention Registry Preliminary Report
What are the outcomes of fetal cardiac intervention (FCI) in an international, multicenter registry?
The database of the International Fetal Cardiac Intervention Registry (IFCIR) was queried for details of diagnosis, procedures, and outcomes. Registry data from January 2001-June 2014 were included.
Eighteen centers submitted data to the registry. A total of 370 cases were entered, of which 245 underwent FCI (86 aortic and 16 pulmonary valvuloplasties, 37 atrial septal cases, and 6 unclassified cases). A total of 100 aortic valvuloplasties from a single center were excluded, as they had been comprehensively reported elsewhere. Fetal death during the procedure occurred in 11% of cases, with fetal death within 48 hours in an additional 6% of cases. Overall survival to first hospital discharge was 49% (53% for aortic valvuloplasty, 38% for pulmonary valvuloplasty, and 49% for atrial septal interventions). For live-born infants with aortic stenosis who had a successful intervention, more than twice as many were discharged with biventricular circulation as those without any/successful intervention. Survival to discharge for live-born fetuses with atrial restriction was similar between those undergoing technically successful versus unsuccessful FCI (63.6% vs. 46.7%).
The authors concluded that there is a potential benefit for FCI. Further study will be required to determine the role of fetal intervention in various congenital heart lesions.
This study is the first report of a multicenter registry of fetal interventions. A registry is an appealing means of investigating outcomes of FCIs given the relative infrequency of these procedures. Periprocedural fetal mortality in this report was relatively high. However, many centers were relatively early in their experience and reported a small number of procedures. It is likely that results will improve as centers advance on the procedural learning curve. Patients with single ventricle lesions and restrictive atrial septum appear to remain a high risk group with or without intervention. Challenges remain in understanding the impact of fetal aortic valvuloplasty on improving the chances of an eventual biventricular repair, as it is difficult to be sure of the natural history of an individual’s disease process without intervention.
Keywords: Aortic Valve Stenosis, Atrial Septum, Balloon Valvuloplasty, Fetal Death, Fatal Outcome, Heart Defects, Congenital
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