Latin American Multicenter Study of Fetal Endoscopic Tracheal Occlusion for Severe Left Diaphragmatic Hernia

OBJECTIVE: To evaluate the survival outcomes of fetuses with severe left congenital diaphragmatic hernia (CDH) treated with fetal endoscopic tracheal occlusion (FETO) in Latin American centers. METHOD: A retrospective cohort including fetuses with isolated left CDH and severe pulmonary hypoplasia (observed/expected lung area to head ratio (O/E-LHR) < 35% with liver herniation) treated with FETO in five Latin-American countries was compared to a contemporary control group with similar lung size but managed expectantly during pregnancy. Propensity score matching and multivariate logistic regression were used to compare survival outcomes between cases with and without FETO. RESULTS: 360 fetuses with severe left CDH were included, 180 treated with FETO were compared with 180 contemporaneous cases managed expectantly during pregnancy with similar O/E-LHR values (25.2 vs. 25.7, p = 0.50). FETO was performed at a mean GA of 28.4 (ranges, 24.0-32.0) weeks. Balloon removal was performed at a mean GA of 33.8 (ranges, 28.4-38.0) weeks. The mean duration of tracheal occlusion was 37.5 (ranges, 2.0-84.0) days. The FETO group showed significantly lower GA at delivery (35.2 vs. 37.0 weeks, respectively, p < 0.001), and higher incidence of preterm prelabor rupture of membranes (47.8% vs. 20.0%, p = < 0.001). The neonatal survival rate was significantly higher in the FETO group compared with the expectant care group (39.4% vs. 8.9%, respectively, p < 0.001) (odds ratio: 14.8; 95% confidence interval [CI]: 7.1-30.9; p < 0.001). CONCLUSIONS: In Latin American centers, FETO was associated with a significant increase in survival among fetuses with left CDH and severe lung hypoplasia.