Abstract 3036: The Relationship Between Cardiovascular Status and Recipient Twin Outcomes in Twin-Twin Transfusion Syndrome: Assessment by Fetal Cardiovascular Profile Score
Background: Cardiac findings in the recipient twin (RT) in twin-twin transfusion syndrome (TTTS) are well described, but not routinely assessed in most centers. The relationship between cardiovascular findings and RT outcome has not been conclusively established. The fetal cardiovascular profile score (CVPS) has been proposed as one method of assessing cardiovascular well-being in at-risk fetuses.
Purpose: To assess the relationship between fetal CVPS and RT outcome in pregnancies complicated by TTTS.
Methods: A retrospective review of fetal echocardiography and outcomes data in 43 consecutive pregnancies with TTTS was performed. The primary outcome variable was postnatal RT survival to 30 days of life. The CVPS consists of a 10 point scoring of fetal cardiovascular status with 1–2 point deductions for hydrops, abnormal vascular Doppler findings, cardiomegaly, and myocardial dysfunction. CVPS was retrospectively assigned to each RT at initial evaluation by a single investigator. Thirty day postnatal survival was compared between groups using chi-squared analysis and odds of survival computed using logistic regression.
Results: Overall, postnatal 30 day survival for either twin was 63% (54/86), with RT survival of 53% (23/43). Grouped by CVPS, the RT survival was 0% (0/8) for CVPS <9, 43% (3/7) for CVPS = 9, and 71% (20/28) for CVPS = 10 (χ2 = 13.1, p < 0.01). Survival of RT with initial CVPS of 10 was substantially greater than RT with CVPS < 10 (Odds ratio 7.1, 95% confidence interval 1.8–28.9).
Conclusions: A normal CVPS in RT of pregnancies complicated by TTTS is predictive of substantially improved survival compared to RT with abnormal cardiovascular findings. Importantly, even minor deductions in CVPS are associated with substantially increased risk of RT mortality. Careful cardiac assessment with use of the CVPS may improve clinical decision making and timing of fetal therapeutic interventions.