Fetal Surgery Using Fetoscopic Endoluminal Tracheal Occlusion for Severe Congenital Diaphragmatic Hernia: a Single-center Experience

Overview

Journal Arch Gynecol Obstet

Specialty Gynecology & Obstetrics

Date 2023 Oct 3

PMID 37789206

Authors

Ana Idelson

Kinneret Tenenbaum-Gavish

David Danon

Nir-Ram Duvdevani

Ruben Bromiker

Gil Klinger

Sharon Orbach-Zinger

Anastasia Almog

Adi Sharabi-Nov

Hamutal Meiri

Kypros H Nicolaides

Arnon Wiznitzer

Yuval Gielchinsky

Affiliations

Soon will be listed here.

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.

Citing Articles

Fetoscopic Endoluminal Tracheal Occlusion-Synergic Therapies in the Prenatal Treatment of Congenital Diaphragmatic Hernia.

Bara Z, Gozar H, Nagy N, Gurzu S, Derzsi Z, Forro T Int J Mol Sci. 2025; 26(4).

PMID: 40004103 PMC: 11855672. DOI: 10.3390/ijms26041639.

References

Deprest J, Nicolaides K, Benachi A, Gratacos E, Ryan G, Persico N . Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia. N Engl J Med. 2021; 385(2):107-118. PMC: 7613453. DOI: 10.1056/NEJMoa2027030. View

Langham Jr M, Kays D, Ledbetter D, Frentzen B, Sanford L, Richards D . Congenital diaphragmatic hernia. Epidemiology and outcome. Clin Perinatol. 1996; 23(4):671-88. View

Harting M, Lally K . The Congenital Diaphragmatic Hernia Study Group registry update. Semin Fetal Neonatal Med. 2014; 19(6):370-5. DOI: 10.1016/j.siny.2014.09.004. View

Raval M, Wang X, Reynolds M, Fischer A . Costs of congenital diaphragmatic hernia repair in the United States-extracorporeal membrane oxygenation foots the bill. J Pediatr Surg. 2011; 46(4):617-624. DOI: 10.1016/j.jpedsurg.2010.09.047. View

Zani A, Chung W, Deprest J, Harting M, Jancelewicz T, Kunisaki S . Congenital diaphragmatic hernia. Nat Rev Dis Primers. 2022; 8(1):37. DOI: 10.1038/s41572-022-00362-w. View

Jani J, Peralta C, Nicolaides K . Lung-to-head ratio: a need to unify the technique. Ultrasound Obstet Gynecol. 2012; 39(1):2-6. DOI: 10.1002/uog.11065. View

Done E, Debeer A, Gucciardo L, Van Mieghem T, Lewi P, Devlieger R . Prediction of neonatal respiratory function and pulmonary hypertension in fetuses with isolated congenital diaphragmatic hernia in the fetal endoscopic tracleal occlusion era: a single-center study. Fetal Diagn Ther. 2014; 37(1):24-32. DOI: 10.1159/000364805. View

Van der Veeken L, Russo F, De Catte L, Gratacos E, Benachi A, Ville Y . Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia. Gynecol Surg. 2018; 15(1):9. PMC: 5940711. DOI: 10.1186/s10397-018-1041-9. View

Deprest J, Gratacos E, Nicolaides K . Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol. 2004; 24(2):121-6. DOI: 10.1002/uog.1711. View

10.

Deprest J, Benachi A, Gratacos E, Nicolaides K, Berg C, Persico N . Randomized Trial of Fetal Surgery for Moderate Left Diaphragmatic Hernia. N Engl J Med. 2021; 385(2):119-129. PMC: 7613454. DOI: 10.1056/NEJMoa2026983. View

11.

Persico N, Fabietti I, Ciralli F, Gentilino V, DAmbrosi F, Boito S . Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience. Fetal Diagn Ther. 2016; 41(3):215-219. DOI: 10.1159/000448096. View

12.

Jani J, Nicolaides K, Keller R, Benachi A, Peralta C, Favre R . Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol. 2007; 30(1):67-71. DOI: 10.1002/uog.4052. View

13.

Dekoninck P, Gomez O, Sandaite I, Richter J, Nawapun K, Eerdekens A . Right-sided congenital diaphragmatic hernia in a decade of fetal surgery. BJOG. 2014; 122(7):940-6. DOI: 10.1111/1471-0528.13065. View

14.

Jani J, Nicolaides K, Gratacos E, Valencia C, Done E, Martinez J . Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009; 34(3):304-10. DOI: 10.1002/uog.6450. View

15.

Reiss I, Schaible T, van den Hout L, Capolupo I, Allegaert K, van Heijst A . Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatology. 2010; 98(4):354-64. DOI: 10.1159/000320622. View

16.

Van Calster B, Benachi A, Nicolaides K, Gratacos E, Berg C, Persico N . The randomized Tracheal Occlusion To Accelerate Lung growth (TOTAL)-trials on fetal surgery for congenital diaphragmatic hernia: reanalysis using pooled data. Am J Obstet Gynecol. 2021; 226(4):560.e1-560.e24. DOI: 10.1016/j.ajog.2021.11.1351. View

17.

Chmait R, Chon A, Korst L, Llanes A, Kontopoulos E, Quintero R . Risks of Preterm Premature Rupture of Membranes and Preterm Birth Post Fetoscopy Based on Location of Trocar Insertion Site. Am J Perinatol. 2018; 35(8):801-808. DOI: 10.1055/s-0037-1620268. View

18.

Cannie M, Jani J, De Keyzer F, Allegaert K, Dymarkowski S, Deprest J . Evidence and patterns in lung response after fetal tracheal occlusion: clinical controlled study. Radiology. 2009; 252(2):526-33. DOI: 10.1148/radiol.2522081955. View

19.

Ruano R, Silva M, Campos J, Papanna R, Moise Jr K, Tannuri U . Fetal pulmonary response after fetoscopic tracheal occlusion for severe isolated congenital diaphragmatic hernia. Obstet Gynecol. 2011; 119(1):93-101. DOI: 10.1097/AOG.0b013e31823d3aea. View