Fetoscopic Endoluminal Tracheal Occlusion versus Expectant Management for Severe Congenital Diaphragmatic Hernia at a...

The TOTAL trial showed survival benefit in patients with severe congenital diaphragmatic hernia (CDH) who underwent fetoscopic endoluminal tracheal occlusion (FETO). We aim to add to the current literature by describing implementation, feasibility, and outcomes of patients treated with FETO compared to a contemporary cohort of expectantly managed maternal-child dyads.

A single-center, retrospective cohort study evaluated patients with a prenatal diagnosis of isolated left-CDH with an observed/expected lung-to-head ratio (O/E LHR) <30% referred to our center from September 2016 to January 2023.

Twelve patients who underwent FETO were compared to 35 expectantly managed patients. At initial evaluation, FETO patients had a lower O/E LHR value (21.7% versus 24.9%) compared to the expectant management patients. Chorioamniotic membrane separation occurred in half of the FETO patients (6/12) compared with 1 patient in the expectant management group and most FETO patients (75.0%) experienced preterm prelabor rupture of membranes compared to only 4 (11.4%) expectant management patients. FETO patients had a lower median gestational age at delivery compared to expectant management patients (35.0 vs. 38.9 weeks). Fewer FETO patients were treated with extracorporeal-membrane oxygenation (ECMO; 25.0% vs. 60.0% expectant management). FETO patients also had higher survival (91.7% vs. 71.4%) and longer duration of hospitalization (135 vs. 94.8 days). At time of discharge, no FETO patients required pulmonary hypertension (PH) medications while 28.0% of expectant management patients were on PH medications.

FETO for severe CDH was feasible in our single center setting. FETO may increase risk of obstetric complications and prematurity, but improved ECMO use, PH, and survival of infants with severe CDH.