Oral Concurrent Session 8 - Fetus and Fetal Intervention
Oral Concurrent Sessions
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
Lisa M. Korst, MD, PhD
Childbirth Research Associates
North Hollywood, California, United States
Arlyn Llanes, MHA, RN
Keck School of Medicine, University of Southern California
Los Angeles, California, United States
Kristine R. Rallo, RN
Keck School of Medicine, University of Southern California
Los Angeles, California, United States
Andrew H. Chon, MD
Oregon Health & Science University
Portland, Oregon, United States
Martha A. Monson, MD, MSCI (she/her/hers)
Assistant Professor
Intermountain Healthcare, University of Utah Health
Salt Lake City, Utah, United States
.jpg "Ruben A. Quintero, MD (he/him/his) photo")
Ruben A. Quintero, MD (he/him/his)
The Fetal Institute, USFETUS Research Consortium
Miami, Florida, United States
This is a post hoc analysis of data collected in the Sequential Trial, a randomized controlled trial (RCT) comparing the sequential and selective laser techniques for TTTS patients at 16-26 gestational weeks. Patients received either the original (selective) or a modified selective (sequential) laser surgery, in which arteriovenous (AV) anastomoses with unidirectional blood flow from donor to recipient are laser-ablated first, followed by ablation of AV anastomoses from recipient to donor. This theoretically allows for a net intraoperative blood transfer from the hypervolemic recipient to the hypovolemic donor twin. Those with only 1 AA (AA-1) vs 2 or more AA (AA-2) were identified, and we tested for association for twin survival at birth.
Results:
Of 642 patients in the RCT, 466 (72.6%) had AV anastomoses only (donor survival 90.3%) and 176 (27.4%) had both AV and superficial anastomoses (donor survival 70.5%) (P< .0001). Of the 176 with superficial anastomoses, 112 (63.6%) had AA only, 40 (22.7%) had both AA and VV, and 24 (13.6%) had VV only. For the 152 patients who had at least 1 AA, donor survival differed based on type and number of superficial anastomoses (Figure). In logistic regression models for donor survival controlling for surgical technique, donor critical abnormal Dopplers, and donor middle cerebral artery peak systolic velocity multiples of the median >1.5, patients with AA-2 vs AA-1 were less likely to have donor survival (OR 0.26 [0.08-0.81], P=.0206). Specifically, patients with 2 or more AA and no VV were at risk (Table). The presence of fetal growth restriction was non-contributory. No differences in recipient survival were noted.
Conclusion:
The type and number of superficial anastomoses was associated with donor but not recipient twin survival after laser surgery for TTTS. Poor donor twin survival was associated with presence of AA, particularly in cases lacking a corresponding VV.
