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01-07-2006

Analysis of the stepwise clinical introduction of experimental percutaneous fetoscopic surgical techniques for upcoming minimally invasive fetal cardiac interventions

Authors: T. Kohl, R. Hering, P. Van de Vondel, K. Tchatcheva, C. Berg, P. Bartmann, A. Heep, A. Franz, A. Müller, U. Gembruch

Published in: Surgical Endoscopy | Issue 7/2006

Abstract

Background

This study assessed the feasibility and safety of surgical techniques developed in sheep for fetoscopic fetal cardiac interventions during three selected less complex procedures for noncardiac fetal conditions in humans. On the basis of this assessment, the implications for the clinical introduction of minimally invasive fetoscopic fetal cardiac interventions in the near future are discussed.

Methods

The authors performed 16 percutaneous fetoscopic procedures in 13 human fetuses at between 19 + 2 and 34 + 6 weeks of gestation, then analyzed various parameters of surgical relevance for minimally invasive fetoscopic fetal cardiac interventions. Each of the three noncardiac malformations posed typical surgical challenges that will be critical for the technical success of minimally invasive fetoscopic cardiac interventions.

Results

Overall technical success was achieved in 14 of the 16 procedures. Percutaneous fetoscopic surgery did not result in any untoward effects and was well tolerated by all but two pregnant women: one with bleeding complication and one with mild postoperative pulmonary edema. No fetal complications or injuries from the various percutaneous fetoscopic surgical approaches were observed.

Conclusions

The author’s experience with surgical techniques introduced for percutaneous fetoscopic fetal cardiac intervention in selected noncardiac fetal lesions has led them to believe the time has come for the clinical introduction of fetoscopic fetal cardiac interventions. After an adequate learning curve supervised by committees of human research, the overall outcome and quality of postnatal life for the unborn patients ultimately will determine whether fetoscopic or other fetal cardiac interventions will be better therapeutic alternatives to currently available postnatal procedures.

Bove T, Francois K, De Groote K, Suys B, De Wolf D, Verhaaren H, Matthys D, Moerman A, Poelaert J, Vanhaesebroeck P, Van Nooten G (2004) Outcome analysis of major cardiac operations in low-weight infants. Ann Thorac Surg 76: 181–1872CrossRef

Bruner JP, Richards WO, Tulipan NB, Arney TL (1999) Endoscopic coverage of fetal myelomeningocele in utero. Am J Obstet Gynecol 180(1 Pt 1): 153–158PubMedCrossRef

Graf JL, Bealer JF, Gibbs DL, Adzick NS, Harrison MR (1997) Chorioamniotic membrane separation: a potentially lethal finding. Fetal Diagn Ther 12: 81–84PubMed

Gratacos E, Wu J, Devlieger R, Van de Velde M, Deprest JA (2001) Effects of amniodistension with carbon dioxide on fetal acid-base status during fetoscopic surgery in the sheep model. Surg Endosc 15: 368–372PubMedCrossRef

Harrison MR, Keller RL, Hawgood SB, Kitterman JA, Sandberg PL, Famer DL, Lee H, Filly RA, Farrel JA, Albanese CT (2003) Randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Engl J Med 349: 1916–1924PubMedCrossRef

Kohl T, Große Hartlage M, Westphal M, Kienitz D, Aryee S, Achenbach S, Buller T, Kossobutzki C, Gogarten W, Vogt J, Scheld HH, Van Aken H, Gembruch U (2002) Intraamniotic multimodal fetal echocardiography in sheep: a novel imaging approach during fetoscopic interventions and for assessment of high-risk pregnancies in whom conventional imaging methods fail. Ultrasound Med Biol 28: 731–736PubMedCrossRef

Kohl T, Kirchhof P, Gogarten W, Asfour B, Haverkamp W, Reckers J, Eckard L, Markus M, Van Aken H, Breithard J, Vogt J, Scheld HH (1999) Fetal transesophageal electrocardiography and stimulation in sheep: fetoscopic techniques aimed at diagnosis and therapy of incessant fetal tachycardias. Circulation 100: 772–776PubMed

Kohl T, McElhinney DB, Farrel J, Harrison MR, Scheld HH, Vogt J, Silverman NH (1996) Fetoplacental blood flow predicts outcome after open fetal surgery for diaphragmatic hernia (abstract). Ped Res 43(Suppl): 23

Kohl T, McElhinney DB, Farrel J, Scheld HH, Vogt J, Harrison MR, Silverman NH (1999) Impact of fetoscopic versus open fetal surgery on fetoplacental blood flow and outcome in human fetuses (abstract). Eur Heart J 20(Suppl): 644A

10.

Kohl T, Reckers J, Strümper D, Große Hartlage M, Gogarten W, Gembruch U, Vogt J, Van Aken H, Scheld HH, Paulus W, Rickert CH (2004) Amniotic air insufflation during minimally invasive fetoscopic fetal cardiac interventions is safe for the fetal brain in sheep. J Thorac Cardiovasc Surg 128: 467–471PubMedCrossRef

11.

Kohl T, Strümper D, Witteler R, Merschhoff G, Aleksiene R, Callenbeck C, Asfour B, Reckers J, Aryee S, Vahlhaus C, Vogt J, Van Aken H, Scheld HH (2000) Fetoscopic direct fetal cardiac access in sheep: an important experimental milestone along the route to human fetal cardiac intervention. Circulation 102: 1602–1604PubMed

12.

Kohl T, Szabo Z, Suda K, Harrison MR, Quinn TM, Petrossian E, Hanley FM (1997) Percutaneous fetal access and uterine closure for fetoscopic surgery: lessons from 16 consecutive procedures in pregnant sheep. Surg Endosc 11: 819–824PubMedCrossRef

13.

Kohl T, Szabo Z, Suda K, Petrosian E, Ko E, Kececioglu D, Moore P, Silverman NH, Harrison MR, Chou TM Hanley FL (1997) Fetoscopic and open transumbilical fetal cardiac catheterization in sheep: potential approaches for human fetal cardiac intervention. Circulation 95: 1048–5310PubMed

14.

Kohl T, Westphal M, Strümper D, Achenbach S, Halimeh S, Petry P, Aryee S, Buller T, Aleksiene R, Asfour B, Witteler R, Vogt J, Van Aken H, Scheld HH (2001) Multimodal fetal transesophageal echocardiography for fetal cardiac intervention in sheep. Circulation 114: 1757–1760

15.

Kohl T, Witteler R, Strümper D, Gogarten W, Asfour B, Reckers J, Merschhoff G, Marcus AE, Weyand M, Van Aken H, Vogt J, Scheld HH (2000) Operative techniques and strategies for minimally invasive fetoscopic fetal cardiac interventions in sheep. Surg Endosc 14: 424–430PubMedCrossRef

16.

Luks FI, Deprest JA, Marcus M, Vandenberghe K, Vertommen JD, Lerut T, Brosens I (1994) Carbon dioxide pneumamniosis causes acidosis in fetal lambs. Fetal Diagn Ther 9: 105–109PubMedCrossRef

17.

Luks FI, Peers KH, Deprest JA, Lerut TE, Vandenberghe K (1996) The effect of open and endoscopic fetal surgery on uteroplacental oxygen delivery in the sheep J Pediatr Surg 31: 310–314PubMedCrossRef

18.

Reddy VM, McElhinney DB, Sagrado T, Parry AJ, Teitel DF, Hanley FL (1999) Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2,500 grams. J Thorac Cardiovasc Surg 117: 324–331PubMedCrossRef

19.

Sayki Y, Litwin DE, Bigras JL, Waddel J, Konig A, Baik S, Navsarikar A, Rebeyka IM (1997) Reducing the deleterious effects of intrauterine CO₂ during fetoscopic surgery. J Surg Res 69: 51–54CrossRef

20.

Tworetzky W, Wilkins-Haug L, Jennings RW, van der Velde ME, Marshall AC, Marx GR, Colan SD, Benson CB, Lock JE, Perry SB (2004) Balloon dilation of severe aortic stenosis in the fetus: potential for prevention of hypoplastic left heart syndrome: candidate selection, technique, and results of successful intervention. Circulation 110: 2125–2131PubMedCrossRef

Title: Analysis of the stepwise clinical introduction of experimental percutaneous fetoscopic surgical techniques for upcoming minimally invasive fetal cardiac interventions
Authors: T. Kohl
R. Hering
P. Van de Vondel
K. Tchatcheva
C. Berg
P. Bartmann
A. Heep
A. Franz
A. Müller
U. Gembruch
Publication date: 01-07-2006
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 7/2006
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-005-0662-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of the stepwise clinical introduction of experimental percutaneous fetoscopic surgical techniques for upcoming minimally invasive fetal cardiac interventions

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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