(788) Elevated middle cerebral artery peak systolic velocity and donor twin demise in twin-twin transfusion syndrome

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Jimmy Espinoza, MD, MSc

Professor
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Coauthor(s)

Ramesha Papanna, MD, MPH

Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Anthony Johnson, DO

Professor
McGovern Medical School University of Texas Health Science Center at Houston (UThealth)
Houston, Texas, United States
Eric P. Bergh, MD

Associate Professor
Nemours Children's Health
Wilmington, Delaware, United States
GV

Gustavo Vilchez, MD, MSCR

UTHealth Houston
Houston, Texas, United States
Edgar A. Hernandez-Andrade, MD, PhD (he/him/his)

Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sami Backley, MD

Clinical Fellow PGY 9
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Felicia V. LeMoine, MD (she/her/hers)

Fetal Intervention Fellow
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
SZ

Sen Zhu, PhD

McGovern Medical School at the University of Texas
Houston, Texas, United States
AL

Arlyn Llanes, MHA, RN

Keck School of Medicine, University of Southern California
Los Angeles, California, United States
Ramen H. Chmait, MD (he/him/his)

Director, Los Angeles Fetal Surgery; Professor, Department of Obstetrics and Gynecology
Keck School of Medicine, University of Southern California
Los Angeles, California, United States

Objective: To determine the association of elevated donor middle cerebral artery peak systolic velocity (MCA-PSV) without twin anemia polycythemia sequence (TAPS) and fetal demise among pregnancies complicated by twin-to-twin transfusion syndrome (TTTS).

Study Design: This prospective cohort study included TTTS cases that underwent laser surgery between 2006 and 2023 at two referral centers. The study was designed to: 1) explore the association of elevated donor MCA-PSV ( >1.5 multiples of the median) without TAPS with fetal demise of the donor twin; 2) to evaluate if donor or recipient MCA-PSV is associated with an increased risk for their corresponding fetal death using receiving operator characteristic curve analysis. TAPS was defined as donor MCA-PSV >1.5 MoM and recipient MCA-PSV < 1.0 MoM or intertwin MCA PSV difference >0.5. Uni- and multivariable as well as Poisson (Zou’s method) regression models were used to estimate odd ratios and relative risks (RR) of elevated donor MCA-PSV without TAPS for donor demise, adjusted for TAPS, TTTS stage, intertwin size discordance >25%, low donor MCA pulsatility index, gestational age at surgery, and other confounders.

Results:

Of 1,602 TTTS cases, 3.3% (n=53) had elevated donor MCA-PSV without TAPS and comprised our cases, which were compared to the other 1,549 cases (controls). Clinical characteristics are shown in Table 1; donor demise rate was higher among cases than controls [45.3% (23/53) vs. 13.2% (205/1549), p< 0.001]. 1) Elevated donor MCA-PSV without TAPS was an independent risk factor for donor fetal demise (RR: 2.86; 95 % CI: 1.78-4.59; p< 0.001), and conferred the highest relative risk for demise of the donor twin (Table 2). 2) Donor MCA-PSV was associated with donor fetal demise (AUC: 0.61; p< 0.001), but recipient MCA-PSV was not associated with recipient fetal demise (AUC: 0.54; p=0.2).

Conclusion: 1) Isolated elevated donor MCA-PSV prior to laser is an important risk factor for donor fetal demise, adjusted for confounders including TAPS; 2) The association of TAPS with fetal death may be driven by elevated donor MCA-PSV, not by recipient twin MCA-PSV.