Fetal surgery using fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: a single-center experience

Arch Gynecol Obstet. 2024 Jul;310(1):345-351. doi: 10.1007/s00404-023-07215-1. Epub 2023 Oct 3.

Abstract

Purpose: To provide a comprehensive report of the experience gained in the prenatal treatment of congenital diaphragmatic hernia (CDH) using fetoscopic endoluminal tracheal occlusion (FETO) following its implementation at a newly established specialized fetal medicine center.

Methods: Mothers of fetuses with severe CDH were offered prenatal treatment by FETO.

Results: Between 2018 and 2021, 16 cases of severe CDH underwent FETO. The median gestational age (GA) at balloon insertion was 28.4 weeks (IQR 27.8-28.6). The median GA at delivery was 37 weeks (IQR 34.4-37.8). The survival rate was 8/16 cases (50%). None of the survivors required home oxygen therapy at 6 months of age. Comparison between the survivors and deceased showed that survivors had balloon insertion 1 week earlier (27.8 vs. 28.4 weeks, p = 0.007), a higher amniotic fluid level change between pre- to post-FETO (3.4 vs 1.3, p = 0.024), a higher O/E LHR change between pre- to post-FETO (50.8 vs. 37.5, p = 0.047), and a GA at delivery that was 2 weeks later (37.6 vs. 35.4 weeks, p = 0.032).

Conclusions: The survival rate at 6 months of age in cases of severe CDH treated with FETO in our center was 50%. Our new fetal medicine center matches the performance of other leading international centers.

Keywords: Congenital diaphragmatic hernia (CDH); FETO; Fetal surgery; Fetal therapy; Fetoscopy.

MeSH terms

  • Adult
  • Balloon Occlusion* / methods
  • Female
  • Fetal Therapies / methods
  • Fetoscopy* / methods
  • Gestational Age*
  • Hernias, Diaphragmatic, Congenital* / surgery
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Retrospective Studies
  • Survival Rate
  • Trachea* / surgery
  • Treatment Outcome