Right ventricular outflow tract obstruction in twin‐to‐twin transfusion syndrome undergoing laser surgery: A systematic review and meta‐analysis-Reference-Cited by-同舟云学术

Right ventricular outflow tract obstruction in twin‐to‐twin transfusion syndrome undergoing laser surgery: A systematic review and meta‐analysis

Published:2024-03-14 Issue:8 Volume:103 Page:1513-1521
ISSN:0001-6349
Container-title:Acta Obstetricia et Gynecologica Scandinavica
language:en
Short-container-title:Acta Obstet Gynecol Scand

Author:

Mustafa Hiba J.¹²^ORCID,Jawwad Muhammad³,Iqbal Mansoor Ayesha³,Pagani Giorgio⁴^ORCID,D'Antonio Francesco⁵^ORCID,Khalil Asma⁶⁷⁸

Affiliation:

1. Division of Maternal‐Fetal Medicine Indiana University School of Medicine Indianapolis Indiana USA

2. The Fetal Center at Riley Children's and Indiana University Health Indianapolis Indiana USA

3. Department of Medicine and Surgery Dow University of Health and Sciences Karachi Pakistan

4. Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, ASST‐Papa Giovanni XXIII Bergamo Italy

5. Center for Fetal Care and High‐Risk Pregnancy, Department of Obstetrics and Gynecology University Hospital of Chieti Chieti Italy

6. Fetal Medicine Unit, St George's Hospital St George's University of London London UK

7. Vascular Biology Research center, Molecular and Clinical Sciences Research Institute, St George's University of London London UK

8. Twins Trust center for Research and Clinical Excellence, St George's University of London London UK

Abstract

AbstractIntroductionWe aimed to investigate the incidence, prenatal factors and outcomes of twin‐to‐twin transfusion (TTTS) with right ventricular outflow tract obstruction (RVOTO).Material and methodsA systematic search was conducted to identify relevant studies published until February 2023 in English using the databases PubMed, Scopus and Web of Science. Studies reporting on pregnancies with TTTS and RVOTO were included. The random‐effect model pooled the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals. Heterogeneity was assessed using the I2 value.ResultsA total of 17 studies encompassing 4332 TTTS pregnancies, of which 225 cases had RVOTO, were included. Incidence of RVOTO at time of TTTS diagnosis was 6%. In all, 134/197 (68%) had functional pulmonary stenosis and 62/197 (32%) had functional pulmonary atresia. Of these, 27% resolved following laser and 55% persisted after birth. Of those persisting, 27% required cardiac valve procedures. Prenatal associations were TTTS stage III (53% vs 39% in no‐RVOTO), stage IV TTTS (28% in RVOTO vs 12% in no‐RVOTO) and ductus venosus reversed a‐wave (60% in RVOTO vs 19% in no‐RVOTO). Gestational age at laser and gestational age at delivery were comparable between groups. Survival outcomes were also comparable between groups, including fetal demise of 26%, neonatal death of 12% and 6‐month survival of 82% in RVOTO group. Findings were similar when subgroup analysis was done for studies including head‐to‐head analysis.ConclusionsRVOT occurs in about 6% of the recipient twins with TTTS, especially in stages III and IV and those with reversed ductus venosus a‐wave. The findings from this systematic review support the need for a thorough cardiac assessment of pregnancies complicated by TTTS, both before and after laser, to maximize perinatal outcome, and the importance of early diagnosis of TTTS and timely management.

Publisher

Wiley

Link

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/aogs.14825

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