Fetal Surgery 2016 Innovation Summit

Fetal Surgery

2016 Innovation SummitDavid Lynch-Salamon, MDMedical DirectorMidwest Fetal Care Center

1. Accurate diagnosis and staging possible, with exclusion of associated anomalies.2. Natural history of the disease is documented, and prognosis is established.3. Currently no effective postnatal therapy.4. In utero surgery proven feasible in animal models, reversing deleterious effects of the condition.5. Interventions performed in specialized multidisciplinary fetal treatment centers within strict protocols and approval of the local Ethics Committee with informed consent of the mother or parents.

Criteria for Fetal SurgeryHarrison et al, NEJM, 1982

Fetal TherapyTransplacentalNeedle basedFetoscopicOpen

BetamethasoneAntiarrhythmic drugsThyroid medication

Transplacental

Cordocentesis for transfusion or medication administrationShunt placementAblation of vascular connectionsNeedle Based

Disorders of monochorionic placentationTTTSTAPSsIUGRTRAPAmniotic band sequenceFETOSpina bifida repairLower urinary tract obstruction (LUTO)

Fetoscopic

Spina bifidaLUTOCongenital pulmonary airway malformations (CPAM)Sacrococcygeal teratomaOther massesOpen Repairs

Fetal MMC Repair

Prospective and randomizedPrenatl vs postnatal repair

NEJM 2011Less need for VP shunt in first year (44% vs 84%)Improved mental/motor composite score at 30 monthsLess need for intermittent catheterization (38% vs 51%)DurableMOMS Trial

Prospective and randomizedLaser vs amnioreductionStopped early due to significant benefit in laser groupNEJM 2004Better survival of at least one twin at 28 days (76% vs 56%)More likely to be free of neurologic complications (52% vs 31%)

Laser for TTTS

Laryngeal Atresia

9 mm

Sagittal US at 25 3/7 weeks

Head US at 25 3/7 weeks

US Guided Decompression of the Distal Trachea

US Guided Decompression of the Distal Trachea

US Guided Decompression of the Distal Trachea

Immediate Post Procedure Sagittal US

Head US at 29 Weeks

20152016 YTDPeds Cards Echos747672Laser1520Bladder Shunt2 Patients 4 Procedures2 Patients4 ProceduresPUBS4 Patients6 Procedures2 Patients8 ProceduresComplicated Mono12Thoracentesis02Tracheocentesis01MMC03

MWFCC Procedures