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July 26, 2026BMC Pregnancy and ChildbirthOpen Access

Fetal cardiac interventions versus expectant management in congenital heart disease: a systematic review and meta-analysis

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Key result

Fetal cardiac intervention was associated with significantly lower odds of postnatal death among live-born infants compared with expectant management (OR 0.457), without a significant difference in live birth rates.

Why the study?

To evaluate biventricular circulation, live birth, and postnatal mortality after fetal cardiac intervention compared with expectant management, and examine outcomes by technical success of FAV.

Does fetal cardiac intervention improve biventricular circulation, live birth, and postnatal mortality in fetuses with congenital heart disease compared to expectant management?

Population

775 fetuses across 11 independent comparative study populations

Comparison

Fetal cardiac intervention vs expectant management

Design

Systematic review and meta-analysis of observational studies

Authors

PNPeng NingJLJ H LiuSLShuting Lin

Discussion

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Member takes

Overview

Supports FCI to lower postnatal mortality in fetal CHD; extends Level 1 meta-analytic evidence for select lesions.

Key Points

  • This review evaluates outcomes of biventricular circulation, live birth, and postnatal mortality after fetal cardiac intervention compared to expectant management.
  • Conducted a systematic review and meta-analysis following PRISMA guidelines.
  • Included 11 comparative reports with a total of 775 fetuses (418 interventions and 357 controls).
  • Used random-effects meta-analyses to assess outcomes and techniques.
  • Live birth rates were similar between FCI (86.0%) and expectant management (90.0%) groups (OR 0.680, 95% CI 0.350–1.320; p = 0.256).
  • Postnatal mortality was significantly lower in the FCI group (19.6%) compared to the expectant management group (32.8%) (OR 0.457, 95% CI 0.280–0.746; p = 0.002).
  • Technically successful FAV resulted in higher odds of biventricular circulation and live birth compared to unsuccessful procedures.

Study Design

Type

Meta-Analysis (n=775)

Structured PICO

Does fetal cardiac intervention improve biventricular circulation, live birth, and postnatal mortality in fetuses with congenital heart disease compared to expectant management?

P
Population
775 fetuses with severe congenital heart disease included in 11 comparative cohorts evaluating fetal cardiac interventions versus expectant management.
I
Intervention
Fetal cardiac intervention (FCI), including fetal aortic valvuloplasty (FAV), fetal pulmonary valvuloplasty (FPV), and fetal atrial septal intervention (FASI).
C
Comparator
Expectant management.
O
Outcome
Biventricular circulation (BVC), live birth, and postnatal mortality.hard clinical

Main Result

Odds Ratio: 0.457 (95% CI 0.28–0.746)

Absolute Event Rate: 19.6% vs 32.8%

p-value: p=0.002

Fetal cardiac intervention, particularly fetal aortic valvuloplasty, is associated with significantly lower postnatal mortality among live-born infants compared to expectant management, though evidence for other interventions remains sparse.

Limitations

  • Lack of randomized controlled trials, as all included studies were observational
  • Outcomes may be affected by operator experience, fetal selection criteria, procedural strategies, and perinatal management practices across centers
  • FPV and FASI subgroup analyses included few cohorts, making conclusions exploratory
  • Technical-success-stratified postnatal mortality data were available from only two cohorts, limiting statistical precision
  • One FAV cohort did not provide extractable comparative live-birth or postnatal-death data for both study arms
  • Comparative evidence for FPV and FASI remains sparse, making findings exploratory

Cite This Study

Ning et al. (2026) conducted a meta-analysis in Congenital heart disease (n=775). Fetal cardiac intervention vs. Expectant management was evaluated on Postnatal death among live-born infants (OR 0.457, 95% CI 0.280-0.746, p=0.002). Fetal cardiac intervention was associated with significantly lower odds of postnatal death among live-born infants compared with expectant management (OR 0.457), without a significant difference in live birth rates.

synapsesocial.com/papers/6a65a72fd3aea3239cd78230https://doi.org/10.1186/s12884-026-09703-z
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Postnatal circulation in patients with aortic stenosis undergoing fetal aortic valvuloplasty: systematic review and meta‐analysis2021 · 20 citations
  2. 2Complications Associated with Fetal Cardiac Interventions: Prevalence and Management – Experience from 213 Procedures2022 · 17 citations
  3. 3Procedural, pregnancy, and short‐term outcomes after fetal aortic valvuloplasty2020 · 36 citations
  4. 4Postnatal outcome following fetal aortic valvuloplasty for critical aortic stenosis2024 · 9 citations
  5. 5Fetal Cardiac Intervention in Critical Aortic Stenosis with Severe Mitral Regurgitation, Severe Left Atrial Enlargement, and Restrictive Foramen Ovale2019 · 27 citations