Stage based survival after fetoscopic laser ablation treatment of twin transfusion syndrome using the 'Solomon-technique'

Objective Solomon laser treatment of twin-twin transfusion syndrome (TTTS) aims to coagulate intertwin anastomoses as well as the chorionic plate along the vascular equator to achieve functional conversion to a dichorionic placenta. Having uniformly offered Solomon Laser to all TTTS it was our goal to investigate twin survival at birth stratified by Quintero severity stage.

Methods Single center cohort study of consecutive TTTS pregnancies intended to receive Solomon laser. Perioperative characteristics and obstetric factors were related to survival at 48 hours and at the time of delivery stratified by Quintero stage. Determinants of twin survival were evaluated using univariate, logistic regression analyses.

Results Between 2014-22, 373 of 380 (98.2%) TTTS patients chose Solomon laser. Among 355 delivered patients, maternal age was 30.9 (±5.3) years, median body mass index 29.2 and the majority were nulliparous 167 (47.0%). Quintero stage 3 was most frequent (155, 43.5%) followed by stage 2 (109, 30.6%), 1 (71 (19.9%) and 4 (20, 5.6%). 113 (31.8%) had coexisting growth restriction of one twin (sIUGR) (Table 1). Solomon technique was successfully applied in 347 (97.7%) with sequential coagulation in 51 (14.4%). Laser was considered complete in 319 (89.9%) and 11 patients (3.1%) required repeat surgery. At 48 hours double survival was above 80% and did not differ between TTTS stages (p=0.292). Overall 85 (23.9%) patients had fetal losses mainly due to donor demise (45/85) and previable birth (15/85). Delivery occurred a median 11.7 weeks after laser at 33+2 weeks gestation. At birth double survival occurred in 270 (76.1%), single survival in 60 (16.9%) while 25 (7%) had no survivors. Double survival was most frequent in stages 1 (84.5%), 4 (85%) and 2 (79.8%) but lowest for stage 3 (68.4%), (p=0.103).

Conclusions Solomon laser achieves resolution of TTTS in a high proportion of cases allowing for disease recovery and double survival. The unequal placental share responsible for stage 3 fetal size discordance is responsible for the lower double survival rate in these patients.

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Artikel online veröffentlicht:
29. August 2023