Congenital heart diseaseCohort study
Technical Success of Fetal Aortic Valvuloplasty in Relation to Center Volumes: A Report From the International Fetal Cardiac Intervention Registry
- Registry cohort
- International Fetal Cardiac Intervention Registry
- institutions performing ≥3 procedures (2001-2018)
- Univariable and Classification and Regression Tree analyses
Authors' conclusion
In this registry cohort, higher-volume centers did not have greater fetal aortic valvuloplasty technical success or fewer complications but did have fewer periprocedural fetal deaths. Fetal gestational age and number of cardiac punctures influenced outcomes, suggesting that unmeasured fetal selection criteria, such as different referral patterns, and technical expertise, indicative of overall center/team experience, may influence fetal survival.
Study context
- Population
- Fetuses undergoing fetal aortic valvuloplasty at institutions performing ≥3 procedures (2001–2018)fetal aortic valvuloplasties at eleven centers, with volumes ranging from 6 to 31 cases
- Participants
- 162 fetuses
- Exposure
- Center volume for fetal aortic valvuloplasty in relation to outcome metrics
- Outcome
- Technical success (≥1 balloon inflation across the aortic valve, with increased antegrade flow across the valve, new aortic regurgitation, or both)
Main finding
As reported in the abstract
Technical success rate
80.2%
Observational data: associations, not effects.
Secondary outcomes
Procedural complications
- Higher volume was not associated with fewer complications
- secondary end point
Fetal periprocedural death (within 48 hours)
- Higher volume was associated with fewer periprocedural fetal deaths
- secondary end point
Drivers of outcomes (Classification and Regression Tree modeling)
- Largest drivers of improved outcomes for all measures were greater estimated fetal weight and gestational age
- A single cardiac puncture was associated with greater technical success and fewer procedural complications after accounting for fetal estimated fetal weight and gestational age
Original publication
Summarised from the published abstract; every number is checked against it