Impact of fetal pulmonary valvuloplasty in in-utero critical pulmonary stenosis: A systematic review and meta-analysis

Background: Untreated critical pulmonary stenosis may develop into pulmonary atresia with intact ventricular septum, which is associated with a high risk of morbidity and mortality both in fetuses and neonates. In this meta-analysis, we sought to discover the potential of fetal pulmonary valvuloplasty that might affect patients' survival compared to other available procedures. Methods: This systematic review and meta-analysis were conducted based on the PRISMA guideline. The authors thoroughly searched the recognized and potential interventions for PA-IVS, including FPV, total ventricular repair, and palliative procedures. The primary outcome was the mortality rate. We used R software (version 4.1.3) to calculate the overall proportion using the random-effects model of proportional meta-analysis. Results: The FPV procedure was performed at a mean gestational age of 26.28 weeks (95%CI: 24.83-27.73) and was successful in 87.6 % (95 % CI: 78.3-96.3 %) of patients. A total of 52.9 % patients attained biventricular circulation postnatally (95 % CI: 31.2-74.7 %). Successful FPV was associated with a slightly higher overall mortality rate [periprocedural death 4.7 % (95%CI: 0-10.7 %) and postnatal death 8 % (95%CI: 3-13 %)] compared to the three currently available definitive therapies, namely the Fontan procedure [10 % (95%CI: 4-17 %)], 1.5V repair [11 % (95%CI: 5-17 %), and 2V repair [8 % (95%CI: 1-15 %)]. Conclusion: FPV can potentially increase the likelihood of biventricular circulation in fetuses with critical pulmonary valve stenosis.