Fetal aortic valvuloplasty: A single center retrospective review of the last 10 years

Abstract

Introduction

Fetal aortic stenosis (FAS) has a poor prognosis. Fetal aortic valvuloplasty (FAV) has been proposed to improve post-natal outcome by promoting left ventricular (LV) growth. Data on long-term evolution of patients who received FAV are scarce.

Objective

Report our retrospective single center experience on FAV focusing on post-natal evolution of the patients.

Methods

All fetuses with FAV were retrospectively included. Fetal, FAV and neonatal data were recorded. Univentricular or biventricular strategies (UniV or BiV) at birth were collected as well as type of intervention. Causes of death and follow-up (FU) were reviewed.

Results/Expected results

Fifty-eight fetuses with critical AS received 63 FAV at a mean gestational age of 24.6 weeks between 2011 and 2022. At the time of FAV, LV end diastole Z-score varied from –3 to +3. Technical procedural success was reported in 50/58 fetuses. There were 9 in utero demises and 9 terminations of pregnancy (TOP). Thirty eight newborns were delivered at a mean gestational age of 38.1 weeks (8/38 preterms) and a mean weight of 2925 grams (1270–3220 grams). In total, 21 patients required prostaglandin. 9 patients had UniV at birth and 3 patients are still alive. The remaining 29 patients had BiV at birth with 3 univentricular conversion. In the 26 patients with BIV, 23 patients are alive at last FU. Three patients have never been operated on. Thirteen needed one intervention on the aortic valve: 10 had a surgical commissurotomy and 3 had a balloon valvuloplasty. Eleven had 2 interventions and 2 had 3 interventions. Mean age at last FU was 26 [8–112] months.

Conclusion/Perspectives

Severity of FAS is confirmed with 50% of the fetuses alive at last FU. A low incidence of UniV is reported because of high rate of TOP or palliative care at birth. Among patients with BiV, rate of reintervention is high but long-term survival is satisfactory.