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7: Stage-based outcomes of 682 consecutive cases of twin-twin transfusion syndrome treated with laser surgery: the USFetus experience

      Objective

      To describe Stage-specific perinatal outcomes of monochorionic multiples with twin-twin transfusion syndrome (TTTS) treated with selective laser photocoagulation of communicating vessels (SLPCV).

      Study Design

      Patients with TTTS underwent SLPCV at one of two participating centers from March 2002 through March 2010. Patient characteristics and outcome data were collected prospectively and examined by Quintero Stage. A sub-analysis of Stage III patients, dividing them into those with donor affected (Stage IIID), recipient affected (Stage IIIR), or both affected (Stage IIIDR) was also conducted.

      Results

      Of 682 women studied, the Quintero Stage distribution was: 114 Stage I (17%), 177 Stage II (26%), 328 Stage III (48%), and 63 Stage IV (9%). The mean gestational age (GA) ± SD at surgery was 20.6 ± 2.4 weeks, and 32.3 ± 4.4 weeks at delivery. Survival by Stage is described in the Table, and did not differ by participating center. Survival for Stage III fetuses differed depending on whether the donor or recipient was affected. Rates of 30-day donor survival for Stage III subcategories were: Stage IIID (60%), Stage IIIR (78%), and Stage IIIDR (53%) (p = 0.0011). Rates of 30-day recipient survival for Stage III subcategories were: Stage IIID (82%), Stage IIIR (83%), and Stage IIIDR (82%) (p=0.9605).
      Tabled 1
      OutcomeAll PatientsStage IStage IIStage IIIStage IVp-value
      Donor 30-day survival74%81%83%65%82%< 0.0001
      Recipient 30-day survival84%89%86%82%79%0.2146
      At least 1 30-day survival91%93%93%88%92%0.2768
      Dual 30-day survival67%78%76%59%69%< 0.0001

      Conclusions

      Perinatal survival for at least one fetus was approximately 90%. Survival of the recipient was independent of Stage; this is in contrast to other published studies where recipient survival in Stage III/IV has been as low as 12.5%. Survival of the donor, and thus dual survival, appeared to differ only for Stage III. Dual survival in Stage I was 78%. These numbers may be used for patient counseling as well as benchmarks for comparison of surgical results among centers.