(1108) Prenatal Cardiac Predictors of Outcome in Severe Twin-Twin Transfusion (Stage IV TTTS): Largest Center Experience

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Recent systemic review reported lack of data on cardiac predictors of stage IV TTTS outcome. Our objective is to evaluate prenatal cardiac predictors of survival in stage IV TTTS treated with selective fetoscopic laser photocoagulation (SFLP).

Study Design: A retrospective study of stage IV TTTS cases from 2004-2019 treated with SFLP. Exclusion criteria: chromosomal or congenital anomalies, missing survival data at birth and fetal echo. Collected data included demographic, survival at birth and echocardiographic data: right (RV) and left (LV) ventricular Doppler myocardial performance index (MPI); LV and RV diastolic and systolic dysfunction. Statistical analyses were performed using Chi-square or Fisher’s exact test for categorical data as appropriate and p-values < 0.05 as significant. Data were stratified based on recipient twin (RT) survival at birth post SFLP.

Results: 75 stage IV TTTS patients had fetal echocardiography before or within 24 hours after SFLP. Cardiomyopathy was seen in 93% (70/75) of the hydropic recipient twins. The mean gestational age at diagnosis and at delivery was 21.5 ± 2.7 and 30.7 ± 3.6 weeks, respectively. Overall fetal survival at birth was 86% (129/150), while 97% (73/75) of pregnancies had at least one survival. Survival at birth was 84% (63/75) for recipient and 88% (66/75) for donor. Recipient non-survivors compared to recipient survivors had a significantly higher cardiothoracic ratio (0.48± 0.04 vs. 0.41± 0.07, p=0.005); higher incidences of moderate to severe left ventricular systolic dysfunction (55% vs. 15%, p=0.007), as well as functional pulmonary atresia (64% vs. 18%, p= 0.003). There were no significant differences in regard to other cardiac parameters between the two groups

Conclusion: There is a high prevalence of hydropic recipient cardiomyopathy in stage IV TTTS. Hydropic recipients with significant cardiac dysfunction (moderate-severe left ventricular systolic dysfunction and functional pulmonary atresia) are at increased risk of demise despite SFLP. This is important in counseling of patients about outcome and treatment options.

Primary & Presenting Author(s)

Mounria Habli, MD,MSCR
Director of TriHealth Fetal Care Center
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States

Coauthor(s)

KA
Kholoud Arab, MD
Cincinnati Childrens Hospital
Cincinnati, Ohio, United States
Braxton Forde, MD
Assistant Professor
Division of Maternal-Fetal Medicine, University of Cincinnati Medical Center
Cincinnati, Ohio, United States
MH
Mallory Hoffman, MD
Tristate Maternal Fetal Medicine
Cincinnati, Ohio, United States
DM
David McKinney, MD
University of Cincinnati Medical Center
Cincinnati, Ohio, United States
KM
Kara B. Markham, MD
Associate professor MFM
University of Cincinnati
Cincinnati, Ohio, United States
JP
Jose Peiro, MD
Professor Surgery - Director Fetal Care Center
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
FL
Foong Lim, MD
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States