PDF(Pubmed)
Abstract：
BACKGROUND: We aimed to investigate the incidence, prenatal factors and outcomes of twin-to-twin transfusion (TTTS) with right ventricular outflow tract obstruction (RVOTO).
METHODS: A 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.
RESULTS: A 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.
CONCLUSIONS: RVOT 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.
METHODS: A 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.
RESULTS: A 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.
CONCLUSIONS: RVOT 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.
摘要：
背景：我们旨在调查发病率，产前因素和双胎对双胎输血(TTTS)合并右室流出道梗阻(RVOTO)的结局.
方法：使用数据库PubMed进行了系统搜索，以确定直到2023年2月以英文发表的相关研究，Scopus和WebofScience包括有关TTTS和RVOTO妊娠的研究报告。随机效应模型汇集了平均差或比值比(OR)和相应的95%置信区间。使用I2值评估异质性。
结果：共有17项研究，包括4332例TTTS妊娠，其中225例发生了RVOTO，包括在内。TTTS诊断时RVOTO的发生率为6%。总之,134/197（68％）患有功能性肺动脉狭窄，62/197（32％）患有功能性肺动脉闭锁。其中,27％在激光后解决，55％在出生后持续存在。在那些坚持的人中，27%需要心脏瓣膜手术。产前关联为TTTSIII期（无RVOTO为53％vs39％），IV期TTTS(RVOTO为28%,非RVOTO为12%)和静脉导管逆转a波(RVOTO为60%,非RVOTO为19%)。两组之间的激光妊娠年龄和分娩时的胎龄相当。两组之间的生存结果也具有可比性，包括26%的胎儿死亡,RVOTO组新生儿死亡率为12%，6个月生存率为82%。对包括头对头分析在内的研究进行亚组分析时，结果相似。
结论：RVOT发生在大约6％的患有TTTS的双胞胎中，尤其是在III和IV阶段以及具有反向静脉导管a波的阶段。这项系统评价的结果支持需要对并发TTTS的妊娠进行彻底的心脏评估，激光之前和之后，为了最大限度地提高围产期结局，以及TTTS早期诊断和及时管理的重要性。
方法：使用数据库PubMed进行了系统搜索，以确定直到2023年2月以英文发表的相关研究，Scopus和WebofScience包括有关TTTS和RVOTO妊娠的研究报告。随机效应模型汇集了平均差或比值比(OR)和相应的95%置信区间。使用I2值评估异质性。
结果：共有17项研究，包括4332例TTTS妊娠，其中225例发生了RVOTO，包括在内。TTTS诊断时RVOTO的发生率为6%。总之,134/197（68％）患有功能性肺动脉狭窄，62/197（32％）患有功能性肺动脉闭锁。其中,27％在激光后解决，55％在出生后持续存在。在那些坚持的人中，27%需要心脏瓣膜手术。产前关联为TTTSIII期（无RVOTO为53％vs39％），IV期TTTS(RVOTO为28%,非RVOTO为12%)和静脉导管逆转a波(RVOTO为60%,非RVOTO为19%)。两组之间的激光妊娠年龄和分娩时的胎龄相当。两组之间的生存结果也具有可比性，包括26%的胎儿死亡,RVOTO组新生儿死亡率为12%，6个月生存率为82%。对包括头对头分析在内的研究进行亚组分析时，结果相似。
结论：RVOT发生在大约6％的患有TTTS的双胞胎中，尤其是在III和IV阶段以及具有反向静脉导管a波的阶段。这项系统评价的结果支持需要对并发TTTS的妊娠进行彻底的心脏评估，激光之前和之后，为了最大限度地提高围产期结局，以及TTTS早期诊断和及时管理的重要性。
