Stage based recipient and donor outcome in twin-to-twin transfusion syndrome treated by fetoscopic laser surgery using Solomon technique

I Kyvernitakis; M Rosner; A Birk; L Goodman; L Herlands; P Wohlmuth; M Laurie; S Millard; M Kush; J Miller; A A Baschat

doi:10.1002/uog.27620

Stage based recipient and donor outcome in twin-to-twin transfusion syndrome treated by fetoscopic laser surgery using Solomon technique

Ultrasound Obstet Gynecol. 2024 Feb 21. doi: 10.1002/uog.27620. Online ahead of print.

Authors

I Kyvernitakis¹, M Rosner², A Birk², L Goodman², L Herlands², P Wohlmuth¹, M Laurie², S Millard², M Kush², J Miller², A A Baschat²

Affiliations

¹ Section for Prenatal Diagnosis and Fetal therapy, Asklepios Klinik Barmbek, Asklepios Medical School, University of Semmelweis, Hamburg, Germany.
² Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 38379440
DOI: 10.1002/uog.27620

Abstract

Objective: To evaluate twin survival stratified by Quintero stage in patients with twin-to-twin transfusion syndrome (TTTS) after Solomon laser treatment.

Methods: Single center cohort of consecutive twin pregnancies treated with Solomon laser for TTTS. Preoperative Quintero stage, perioperative characteristics and obstetric factors were related to neonatal survival of the recipient and donor at discharge. Determinants of twin survival were evaluated using univariate, logistic regression and cumulative survival probability analyses.

Results: Of 402 twins with TTTS, 80 (19.9%) had stage I, 126 (31.3%) stage II, 169 (42%) stage III and 27 (6.7%) stage IV. Post laser TAPS or recurrent TTTS occurred in 19 (4.7%) patients and 11 (2.7%) required repeat laser. Preterm premature rupture of membranes occurred in 150 (37.3%) patients and median gestational age of delivery 32+1 weeks. In 303 (75.4%) both twins were alive at discharge; [66 (82.5%) in stage I, 101 (80.2%) in stage II, 114 (67.5%) in stage III and 22 (81.5%) in stage IV, p=0.062]. Compared to recipients, donor survival was only lower in stage III (155 (91.7%) recipients vs 118 (69.8%) donors, Chi square 24.685, p<0.0001). Larger intertwin size discordance and umbilical artery (UA) end-diastolic velocity (EDV) determined donor demise (Nagelkerke R² 0.38, P<0.001). Overall, spontaneous post laser donor demise accounted for the majority (39.5%) of all losses. Cumulative donor survival decreased from 92% to 65% with size discordance >30% and 48% when UA EDV was absent (p<0.001).

Conclusion: Solomon laser achieves TTTS resolution and double survival in a high proportion of cases. Recipient and donor survival is comparable unless there is significant size discordance and placental dysfunction. This degree of unequal placental sharing, typically found in stage III, is the primary factor preventing double survival due to a higher rate of donor demise. This article is protected by copyright. All rights reserved.

Keywords: Donor; Equatorial Laser; Recipient; Solomon Laser Surgery; Survival; TTTS; Transfusion Syndrome.