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Fetal Surgery for Congenital Heart Diseases: A Systematic Review and Single-Arm Meta-analysis
Larissa Keren de Azevedo Teixeira1, Henrique Provinciatto2, Gustavo Yano Callado3
1Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul, SP, Brazil.
Insights
Fetal cardiac interventions (FCI) for congenital heart diseases (CHD) show moderate survival rates but high perinatal mortality. Improved patient selection and standardized protocols are crucial for better outcomes in fetal cardiac interventions.
Area of Science:
- Cardiology
- Fetal Medicine
- Pediatric Surgery
Background:
- Congenital heart diseases (CHD) are the most common congenital anomalies.
- Fetal cardiac interventions (FCI) aim to improve perinatal outcomes for fetuses with CHD.
Purpose of the Study:
- To systematically review and meta-analyze observational studies on the effects of FCI on CHD.
- To evaluate the efficacy and safety of intrauterine procedures for fetal cardiac conditions.
Main Methods:
- Systematic search of PubMed/Medline, Embase, and Cochrane Central Register.
- Inclusion of observational cohort studies evaluating intrauterine procedures for CHD.
- Random effects models used for data synthesis; study quality assessed using NOS.
Main Results:
- Analysis of 12 studies with 485 fetuses with CHD.
- Pooled overall survival rate after FCI was 57.4% (95% CI 39.8-73.3).
- Pooled perinatal mortality rate was 31.5% (95% CI 21.0-44.2), with significant heterogeneity observed.
Conclusions:
- FCI for CHD are linked to moderate survival and substantial perinatal mortality.
- Need for standardized protocols, refined patient selection, and multicenter collaboration.
- Improvements are necessary to enhance outcomes and guide clinical decision-making for FCI in CHD.
Introduction:
Congenital heart diseases (CHD) are the most common congenital anomalies, and fetal cardiac interventions (FCI) have been developed to improve perinatal outcomes. We aimed to conduct a systematic review and meta-analysis of observational studies to evaluate the effects of FCI on CHD.
Methods:
We searched PubMed/Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to April 2025 without language restrictions. References of included studies and prior reviews were also screened. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; ID CRD42024599628). Eligible studies included observational cohorts evaluating intrauterine procedures for CHD. Data were synthesized using random effects models in RStudio (version 4.2.2), and study quality was assessed with the Newcastle-Ottawa Quality Assessment Form for Cohort Studies (NOS).
Results:
Twelve studies including 485 fetuses with CHD were analyzed. The pooled overall survival rate after fetal cardiac intervention was 57.4% (95% confidence interval [CI] 39.8-73.3), with survival ranging from 20.0% to 90.2% across studies. The pooled perinatal mortality rate was 31.5% (95% CI 21.0-44.2), with estimates ranging from 9.8% to 66.7%. Substantial heterogeneity was observed for both outcomes (I2 > 75%).
Conclusion:
FCI for CHD are associated with moderate overall survival but substantial perinatal mortality. Standardized protocols, refined patient selection, and multicenter collaboration are needed to improve outcomes and guide clinical decision-making.
