OC02.08: Percutaneous fetal aortic valvuloplasty for critical aortic stenosis

Abstract

To describe our experience with fetal aortic valvuloplasty (FAV) in fetuses with critical aortic stenosis (AS) regarding indications, complications and postnatal outcomes. All FAV performed for critical AS between 2010 and 2019 in our institution were included. Selection criteria included retrograde flow in the aortic arch, left-to-right shunt across foramen ovale, left ventricle (LV) and mitral dimensions >-2SD, moderate or severe LV systolic dysfunction, < 30 weeks' gestation, moderate or severe endocardial fibroelastosis and impaired severe LV diastolic dysfunction. FAV were performed under ultrasound (US) guidance. Balloon inflation across the aortic valve (AV) and amelioration of the anterograde aortic flow across AV defined a technical success. At birth, cardiac US were performed and biventricular circulation (BVC) strategy was decided when the LV systolic and diastolic function were good enough to ensure systemic circulation. In those cases, no treatment or postnatal valvuloplasty were considered. When LV function or size were not suitable for biventricular repair, univentricular circulation (UVC) strategy was chosen and Norwood palliation was performed at birth. 48 procedures were performed in 43 fetuses at 26.3 ± 2.7 weeks of gestation. FAV was successful in 79.2% of the cases. Complications that required in utero reanimation occurred in 29.2% of the cases. Early post-operative intrauterine fetal demise occurred in 11.6% of the cases and 23.2% patients opted for termination of pregnancy (7/10 after a technically successful FAV). 24 patients delivered live born infants at 37.4 ± 3.2 weeks, with BVC in 54.1%. Liveborn infants with a technically successful FAV were more likely to have BVC (70.6%) than those with technically unsuccessful FAV (14.3%, p = 0.04). In our experience, 70.6% of fetuses with critical AS who undergo technically successful FAV have BVC postnatally.