Outcomes of laser surgery for stage I twin‐twin transfusion syndrome. (20th January 2022)

• Record Type: Journal Article
• Authors: Gomez, Nicole G.; Monson, Martha A.; Chon, Andrew H.; Korst, Lisa M.; Llanes, Arlyn; Chmait, Ramen H.
• Is Part Of: Prenatal diagnosis. Volume 42:Number 2(2022)
• Page Start: 172
• Page End: 179
• Publication Date: 2022-01-20
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.6094
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: A recent randomized controlled trial (RCT) demonstrated no difference in 6 month survival in expectantly managed stage I twin‐twin transfusion syndrome (TTTS) patients and those undergoing immediate laser surgery. We aimed to describe outcomes following immediate laser surgery at a single fetal surgery center. Methods: A retrospective study of monochorionic diamniotic twins diagnosed with stage I TTTS who underwent laser surgery between 16 and 26 gestational weeks from 2006 to 2019. The primary outcome was 6 month survivorship. Intact survival was also assessed. Secondarily, outcomes were compared to the RCT expectant management group. Results: Of 126 consecutive stage I TTTS patients, 114 (90.5%) met inclusion criteria. Median (range) gestational age at delivery was 34.1 (20.6–39.4) weeks. At 6 months, the proportion of patients with at‐least‐one survivor in the single‐center‐laser cohort was 97.4%, with 88.6% dual survivorship. Neurological morbidity outcomes were available in 110 pregnancies (220 fetuses). Severe neurological morbidity occurred in 2.7% (6/220), and 6 month survival without severe neurological morbidity was 90.0%. Outcomes compared favorably with the RCT expectant management group. Conclusions: Given favorable survival and neurological outcomes, laser surgery is a reasonable treatment option for stage I TTTS at experienced fetal surgery centers. Further study is warranted to optimize treatment strategies. Key points: What is already known? Optimal treatment strategy for stage I twin‐twin transfusion syndrome (TTTS) is controversial A recent randomized controlled trial (RCT) showed no difference in 6‐month survival in stable stage I TTTS treated with immediate laser surgery versus expectant management What does this study add to the literature? Present study suggests laser surgery remains a reasonable first‐line treatment for stage I TTTS, despite procedure‐related risks