Abstract
Purpose
Severe, progressive twin-to-twin transfusion syndrome (TTTS) is associated with near-100%
mortality if left untreated. Endoscopic laser ablation of placental vessels (ELA)
is associated with 75% to 80% survival of at least one twin. The actuarial risk of
fetal demise after ELA has not yet been described.
Study Design
A retrospective cohort study from 2 centers on a consecutive series of 163 sets of
monochorionic twins with severe TTTS (18 Quintero stage I, 55 stage II, 71 stage III,
19 stage IV) who underwent ELA. Actuarial survival was calculated and stratified for
donor vs recipient and according to stage.
Results
Median gestational age at diagnosis was 20.1 weeks; median operative time was 60 minutes.
Overall survival was 63%, and survival of at least one twin was seen in 76% of pregnancies.
Of fetal demises, 10% occurred within 48 hours after ELA, and 90% of all fetal demises
occurred within 1 month. There was a 10% survival advantage of recipients over donors.
Survival was similar for stages I, II, and IV (75%-80%), compared with 55% for stage
III.
Conclusions
Actuarial survival curves for TTTS confirms a greater burden on donor than on recipient
but not at a previously reported 2:1 ratio. The current staging system does not accurately
reflect post-ELA mortality risk. The unexpected higher mortality in stage III may
reflect a more acute progression of the disorder in this group, an adverse effect
of LA on an as yet unknown subgroup with stage III or, alternatively, preoperative
demise of fulminant stage IV patients, leaving a stage IV subgroup with a more benign
course and better outcome.
Key words
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Article info
Publication history
Accepted:
October 7,
2008
Received:
September 29,
2008
Footnotes
Presented at the 39th annual meeting of the American Pediatric Surgical Association, Phoenix, AZ, May 27-June 1, 2008.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
