A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome.
OBJECTIVE
The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS).


METHODS
This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients.


RESULTS
There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) (P = 1.0, odds ratio [OR] 1, 95% confidence interval [CI] 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) (P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) (P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) (P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) (P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (P = .055, OR 3.025/point) by logistic regression analysis.


CONCLUSIONS
The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.
Crombleholme
Timothy M
TM
Fetal Care Center of Cincinnati, Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital, MLC #2023, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. timothy.crombleholme@cchmc.org
Shera
David
D
Lee
Hanmin
H
Johnson
Mark
M
D'Alton
Mary
M
Porter
Flint
F
Chyu
Jacquelyn
J
Silver
Richard
R
Abuhamad
Alfred
A
Saade
George
G
Shields
Laurence
L
Kauffman
David
D
Stone
Joanne
J
Albanese
Craig T
CT
Bahado-Singh
Ray
R
Ball
Robert H
RH
Bilaniuk
Larissa
L
Coleman
Beverly
B
Farmer
Diana
D
Feldstein
Vickie
V
Harrison
Michael R
MR
Hedrick
Holly
H
Livingston
Jeffrey
J
Lorenz
Robert P
RP
Miller
David A
DA
Norton
Mary E
ME
Polzin
William J
WJ
Robinson
Julian N
JN
Rychik
Jack
J
Sandberg
Per L
PL
Seri
Istvan
I
Simon
Erin
E
Simpson
Lynn L
LL
Yedigarova
Larisa
L
Wilson
R Douglas
RD
Young
Bruce
B
D000328:Adult; D000650:Amnion / Q000601:surgery*; D004200:Diseases in Twins / Q000601:surgery*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods*; D016015:Logistic Models; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014427:Twins