Key result
Fetal pulmonary valvuloplasty enables ~53% of patients to attain postnatal biventricular circulation.
Why the study?
Untreated critical pulmonary stenosis can progress to pulmonary atresia with intact ventricular septum, carrying high fetal and neonatal morbidity and mortality, prompting evaluation of fetal pulmonary valvuloplasty's impact on survival versus other procedures.
Does fetal pulmonary valvuloplasty improve survival and biventricular circulation in fetuses with critical pulmonary stenosis compared to other available procedures?
Meta-Analysis
Does fetal pulmonary valvuloplasty improve survival and biventricular circulation in fetuses with critical pulmonary stenosis compared to other available procedures?
Fetal pulmonary valvuloplasty in critical pulmonary stenosis can potentially increase the likelihood of postnatal biventricular circulation, despite a slightly higher overall mortality rate compared to definitive postnatal therapies.
May support fetal pulmonary valvuloplasty to increase biventricular circulation; leaves open survival benefit versus postnatal strategies.
Background: Untreated critical pulmonary stenosis may develop into pulmonary atresia with intact ventricular septum, which is associated with a high risk of morbidity and mortality both in fetuses and neonates. In this meta-analysis, we sought to discover the potential of fetal pulmonary valvuloplasty that might affect patients' survival compared to other available procedures. Methods: This systematic review and meta-analysis were conducted based on the PRISMA guideline. The authors thoroughly searched the recognized and potential interventions for PA-IVS, including FPV, total ventricular repair, and palliative procedures. The primary outcome was the mortality rate. We used R software (version 4.1.3) to calculate the overall proportion using the random-effects model of proportional meta-analysis. Results: The FPV procedure was performed at a mean gestational age of 26.28 weeks (95%CI: 24.83-27.73) and was successful in 87.6 % (95 % CI: 78.3-96.3 %) of patients. A total of 52.9 % patients attained biventricular circulation postnatally (95 % CI: 31.2-74.7 %). Successful FPV was associated with a slightly higher overall mortality rate [periprocedural death 4.7 % (95%CI: 0-10.7 %) and postnatal death 8 % (95%CI: 3-13 %)] compared to the three currently available definitive therapies, namely the Fontan procedure [10 % (95%CI: 4-17 %)], 1.5V repair [11 % (95%CI: 5-17 %), and 2V repair [8 % (95%CI: 1-15 %)]. Conclusion: FPV can potentially increase the likelihood of biventricular circulation in fetuses with critical pulmonary valve stenosis.
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Mendel et al. (2023) conducted a meta-analysis in In-utero critical pulmonary stenosis. Fetal pulmonary valvuloplasty (FPV) vs. Fontan procedure, 1.5V repair, and 2V repair was evaluated on Mortality rate. Fetal pulmonary valvuloplasty achieved an 87.6% success rate and enabled 52.9% of patients to attain biventricular circulation postnatally, with 4.7% periprocedural and 8% postnatal mortality.
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