Improved technical success, postnatal outcome and refined predictors of outcome for fetal aortic valvuloplasty

• DOI: 10.1002/uog.17530
• Publication Date: 2017-05-23T23:28:16Z
• Authors: K. G. Friedman; L. A. Sleeper; L. R. Freud; A. C. Marshall; M. E. Godfrey; M. Drogosz; T. Lafranchi; C. B. Benson; L. E. Wilkins‐Haug; W. Tworetzky
• Keywords: Aortic valvuloplasty

ABSTRACT Objectives Fetal aortic valvuloplasty (FAV) may prevent progression of mid‐gestation stenosis to hypoplastic left heart syndrome (HLHS). The aim this study was evaluate whether technical success and biventricular (Biv) outcome after FAV have changed from an earlier (2000–2008) a more recent (2009–2015) era identify pre‐FAV predictors Biv outcome. Methods We evaluated procedural postnatal outcomes in 123 fetuses that underwent for evolving HLHS at Boston Children's Hospital between 2000 2015. primary measure circulation type (Biv vs single ventricle) the time neonatal hospital discharge. Classification regression tree (CART) analysis performed construct stratification algorithm predict based on fetal variables. Results procedure technically successful 101/123 (82%) fetuses, with higher rate than one (49/52 (94%) 52/71 (73%); P = 0.003). In liveborn patients, incidence era, both entire cohort (29/49 (59%) 16/62 (26%); 0.001) those whom (27/46 15/47 (32%); 0.007). Independent were ventricular (LV) pressure, larger ascending aorta, better LV diastolic function long‐axis Z ‐score. On CART analysis, pressure > 47 mmHg aorta ‐score ≥ 0.57 had 92% probability ( n 24). Those lower or mitral dimension < 0.1 valve inflow –2 34) unlikely (probability 9%). remainder patients intermediate (∼40–60%) likelihood circulation. Conclusions proportion achieving has increased, probably owing improved modified selection criteria. factors, including size function, are associated FAV. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.