Impact of recipient twin preoperative myocardial performance index in twin-twin transfusion syndrome treated with laser

Objective: To validate the efficacy of laser therapy for twin-twin transfusion syndrome (TTTS) in the treatment of recipient twin cardiomyopathy and investigate whether severity of preoperative cardiomyopathy can predict fetal survival postoperatively. Study design: Retrospective study of monochorionic-diamniotic (MCDA) pregnancies complicated by TTTS treated by selective fetoscopic laser photocoagulation (SFLP) performed between March 2010 and October 2014 at a single center. The recipient right ventricular (RV) and left ventricular (LV) myocardial performance index (MPI) were measured both pre- and postoperatively. The data were analyzed with the Wilcoxon signed rank and parametric t-tests. Results: Forty-three women met inclusion criteria during the study period. There was a substantial improvement in recipient LV (0.570.13 versus 0.43 +/- 0.13, p0.0001) and RV (0.60 +/- 0.16 versus 0.49 +/- 0.18, p0.0001) MPI postoperatively (median=8 days). Recipient preoperative LV and RV MPI did not correlate with recipient or donor survival at 24hours, 7 days or at birth. Thirty-seven recipients (95%) showed improvement in either LV or RV MPI and 22 (56%) showed complete resolution of cardiac dysfunction. Conclusion: Laser treatment for TTTS causes rapid improvement in the cardiac function of recipient fetuses. The severity of recipient preoperative MPI does not correlate with survival of either twin postoperatively.