OBJECTIVE: Fetal aortic valvuloplasty (FAV) became a treatment option for critical fetal aortic stenosis (AS) with the goal to preserve biventricular circulation (BVC). To date, it is unclear how many patients undergoing FAV achieve a BVC. Therefore, the goal of this systematic review/meta-analysis is to investigate the type of postnatal circulation following FAV.
METHODS: The methodology published by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was applied. A systematic search on peri- and postnatal outcome in patients with AS following FAV was performed using MEDLINE, EMBASE, Web of Science and Cochrane Library. All literature was assessed by reading abstracts, excluding duplicates, and if suitable, full text articles were obtained and included. We reviewed publications from 2000 to 2020 including at least 12 months of follow-up. Review papers, comments, books, editorials and case reports were excluded. The primary endpoint was type of postnatal circulation. Additional assessed outcomes included fetal death, live birth, neonatal death (NND), termination of pregnancy (TOP) and technical success of FAV procedure. The quality of articles was assessed using the Critical Appraisal Skills Programme tool (CASP checklist). To estimate the overall proportion of each endpoint, meta-analysis of proportions was employed using a random-effects model.
RESULTS: An electronic search identified 579 studies, of which seven were considered eligible for analysis. A total of 266 fetuses underwent FAV with a follow-up ranging from 12 months to 13.2 years. There were no maternal deaths and only one FAV related maternal complication. Hydrops was present in 25 (9%) patients. Pooled prevalence of BV and UV among all live-born patients were 46% (95% CI: 39.2, 52.4) and 44 %, (95% CI: 33.9, 53.8), respectively. Pooled prevalence of each secondary outcome was, technical successful procedures (82%; 95% CI: 74.3, 87.9), fetal deaths (16%; 95% CI: 11.2-22.4), TOP (6 %; 95% CI: 2.0-15.5), live-births (79 %; 95% CI: 66.5, 87.4), NND (9%; 95% CI 4.7, 15.5), comfort care (4%; 95% CI: 1.9, 8.4), late death (10%; 95% CI: 3.6, 26.1). Pooled prevalence for BV and UV among live-born patients that underwent technical successful procedures were 52% (95% CI: 44.7, 59.1) and 39.8 % (95% CI: 29.7, 50.9), respectively.
CONCLUSIONS: This study showed a BVC rate of 46% among live-born patients with AS undergoing FAV. Bias might be introduced due to the lack of randomized clinical trials and BVC rate improved to 52% when subjects underwent a technically successful FAV. However, currently, data does not suggest a true benefit after FAV towards BVC. This article is protected by copyright. All rights reserved.