title: Long-term morbidity after fetal endoscopic surgery for severe twin-to-twin transfusion syndrome.
abstract: OBJECTIVE
  Severe twin-to-twin transfusion syndrome (TTTS) leads to 80% to 100% dual mortality. Endoscopic laser coagulation of connecting vessels improves outcome to 80% survival of at least 1 twin. There is limited long-term follow-up of surviving TTTS patients. The aim of this study was to analyze gestational age-stratified, long-term morbidity in these patients.
  
  
  METHODS
  A retrospective case-control study of TTTS surviving patients (38 patients, 72% follow-up rate) from one center. Perinatal and pediatric records were reviewed, and outcomes were compared with published reports and gestational age-matched controls.
  
  
  RESULTS
  Forty percent (15/38) had at least 1 major sequela, all but 6 of which were fully resolved at a median follow-up of 4.4 years. There were no permanent cardiac, genitourinary, renal, or respiratory sequelae. All major complications were in patients born <29 weeks. There were no significant differences in complications between this cohort of patients and gestational age (GA)-matched control patients.
  
  
  CONCLUSIONS
  The long-term morbidity of monochorionic twins after fetal laser surgery for severe TTTS is 13%. At a median follow-up of more than 4 years, these children fare no worse than gestational age-matched, non-operated twins and singletons. The degree of prematurity at birth is the best predictor of temporary or permanent sequela in this group of patients.
authors.affiliation: Division of Pediatric Surgery, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI 02905, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kowitt
authors.forename: Richard
authors.initials: R
authors.lastname: Tucker
authors.forename: Debra
authors.initials: D
authors.lastname: Watson-Smith
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Muratore
authors.forename: Barbara M
authors.initials: BM
authors.lastname: O'Brien
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Carr
authors.forename: François I
authors.initials: FI
authors.lastname: Luks
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy; D005333:Fetus / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors