Fetal Surgery for Congenital Heart Diseases: A Systematic Review and Single-Arm Meta-analysis.

IF 4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Therapy Pub Date : 2025-10-18 DOI:10.1007/s12325-025-03388-0

Larissa Keren de Azevedo Teixeira, Henrique Provinciatto, Gustavo Yano Callado, Caroline de Oliveira Nieblas, Roberta Granese, Edward Araujo Júnior

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引用次数: 0

Abstract

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.

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胎儿手术治疗先天性心脏病：一项系统综述和单组meta分析。

前言：先天性心脏病（CHD）是最常见的先天性异常，胎儿心脏干预（FCI）已经发展到改善围产期结局。我们的目的是对观察性研究进行系统回顾和荟萃分析，以评估FCI对冠心病的影响。方法：我们检索了PubMed/Medline、Embase和Cochrane中央对照试验注册库（Central Register of Controlled Trials），从成立到2025年4月，没有语言限制。对纳入研究的参考文献和既往综述也进行了筛选。该方案已在国际前瞻性系统评价登记册（PROSPERO; ID CRD42024599628）中注册。符合条件的研究包括评估宫内手术治疗冠心病的观察性队列。使用RStudio（4.2.2版本）中的随机效应模型综合数据，并使用纽卡斯尔-渥太华队列研究质量评估表（NOS）评估研究质量。结果：对12项研究485例冠心病胎儿进行了分析。胎儿心脏干预后的总生存率为57.4%(95%可信区间[CI] 39.8-73.3)，各研究的生存率为20.0% - 90.2%。围产期总死亡率为31.5% (95% CI 21.0-44.2)，估计范围为9.8%至66.7%。两种结果均观察到显著的异质性（I2 bb0 75%）。结论：CHD的FCI与中等总生存率相关，但与围产期死亡率相关。需要标准化的方案、精细的患者选择和多中心合作来改善结果和指导临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.