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An Overview of Contemporary Outcomes in Fetal Cardiac Intervention: A Case for High-Volume Superspecialization?

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Abstract

Fetal cardiac interventions (FCI) offer the opportunity to rescue a fetus at risk of intrauterine death, or more ambitiously to alter disease progression. Most of these fetuses require multiple additional postnatal procedures, and it is difficult to disentangle the effect of the fetal procedure from that of the postnatal management sequence. The true clinical impact of FCI may only be discernible in large-volume institutions that can commit to a standardized postnatal approach and have sufficient case volume to overcome their FCI learning curve.

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References

  1. Tweddell JS, Hoffman GM, Mussatto KA, Fedderly RT, Berger S, Jaquiss RD, Ghanayem NS, Frisbee SJ, Litwin SB (2002) Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 106:I82–I89

    PubMed  Google Scholar 

  2. Ohye RG, Sleeper LA, Mahony L, Newburger JW, Pearson GD, Lu M, Goldberg CS, Tabbutt S, Frommelt PC, Ghanayem NS, Laussen PC, Rhodes JF, Lewis AB, Mital S, Ravishankar C, Williams IA, Dunbar-Masterson C, Atz AM, Colan S, Minich LL, Pizarro C, Kanter KR, Jaggers J, Jacobs JP, Krawczeski CD, Pike N, McCrindle BW, Virzi L, Gaynor JW and Pediatric Heart Network I (2010) Comparison of shunt types in the norwood procedure for single-ventricle lesions. N Engl J Med. 362:1980–1992

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Newburger JW, Sleeper LA, Gaynor JW, Hollenbeck-Pringle D, Frommelt PC, Li JS, Mahle WT, Williams IA, Atz AM, Burns KM, Chen S, Cnota J, Dunbar-Masterson C, Ghanayem NS, Goldberg CS, Jacobs JP, Lewis AB, Mital S, Pizarro C, Eckhauser A, Stark P, Ohye RG and Pediatric Heart Network I (2018) Transplant-free survival and interventions at 6 years in the SVR trial. Circulation 137:2246–2253

    PubMed  PubMed Central  Google Scholar 

  4. Rogers L, Pagel C, Sullivan ID, Mustafa M, Tsang V, Utley M, Bull C, Franklin RC, Brown KL (2017) Interventions and outcomes in children with hypoplastic left heart syndrome born in England and Wales between 2000 and 2015 based on the National Congenital Heart Disease Audit. Circulation 136:1765–1767

    PubMed  Google Scholar 

  5. Rogers L, Pagel C, Sullivan ID, Mustafa M, Tsang V, Utley M, Bull C, Franklin RC, Brown KL (2018) Interventional treatments and risk factors in patients born with hypoplastic left heart syndrome in England and Wales from 2000 to 2015. Heart 104:1500–1507

    PubMed  Google Scholar 

  6. Wilson WM, Valente AM, Hickey EJ, Clift P, Burchill L, Emmanuel Y, Gibson P, Greutmann M, Grewal J, Grigg LE, Gurvitz M, Hickey K, Khairy P, Mayer JE Jr, Teo E, Vonder Muhll I, Roche SL, Silversides CK, Wald RM (2018) Outcomes of patients with hypoplastic left heart syndrome reaching adulthood after fontan palliation: multicenter study. Circulation 137:978–981

    PubMed  Google Scholar 

  7. Dhanantwari P, Lee E, Krishnan A, Samtani R, Yamada S, Anderson S, Lockett E, Donofrio M, Shiota K, Leatherbury L, Lo CW (2009) Human cardiac development in the first trimester: a high-resolution magnetic resonance imaging and episcopic fluorescence image capture atlas. Circulation 120:343–351

    PubMed  PubMed Central  Google Scholar 

  8. Allan LD, Sharland G, Tynan MJ (1989) The natural history of the hypoplastic left heart syndrome. Int J Cardiol 25:341–343

    CAS  PubMed  Google Scholar 

  9. Vogel M, McElhinney DB, Wilkins-Haug LE, Marshall AC, Benson CB, Juraszek AL, Silva V, Lock JE, Marx GR, Tworetzky W (2011) Aortic stenosis and severe mitral regurgitation in the fetus resulting in giant left atrium and hydrops: pathophysiology, outcomes, and preliminary experience with pre-natal cardiac intervention. J Am Coll Cardiol. 57:348–355

    PubMed  Google Scholar 

  10. Limperopoulos C, Tworetzky W, McElhinney DB, Newburger JW, Brown DW, Robertson RL Jr, Guizard N, McGrath E, Geva J, Annese D, Dunbar-Masterson C, Trainor B, Laussen PC, du Plessis AJ (2010) Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy. Circulation 121:26–33

    CAS  PubMed  Google Scholar 

  11. McElhinney DB, Benson CB, Brown DW, Wilkins-Haug LE, Marshall AC, Zaccagnini L, Tworetzky W (2010) Cerebral blood flow characteristics and biometry in fetuses undergoing prenatal intervention for aortic stenosis with evolving hypoplastic left heart syndrome. Ultrasound Med Biol 36:29–37

    PubMed  PubMed Central  Google Scholar 

  12. Jaeggi E, Renaud C, Ryan G, Chaturvedi R (2016) Intrauterine therapy for structural congenital heart disease: contemporary results and Canadian experience. Trends Cardiovasc Med. 26:639–646

    PubMed  Google Scholar 

  13. Friedman KG, Sleeper LA, Freud LR, Marshall AC, Godfrey ME, Drogosz M, Lafranchi T, Benson CB, Wilkins-Haug LE, Tworetzky W (2018) Improved technical success, postnatal outcome and refined predictors of outcome for fetal aortic valvuloplasty. Ultrasound Obstet Gynecol. 52:212–220

    CAS  PubMed  Google Scholar 

  14. Kovacevic A, Ohman A, Tulzer G, Herberg U, Dangel J, Carvalho JS, Fesslova V, Jicinska H, Sarkola T, Pedroza C, Averiss IE, Mellander M, Gardiner HM and Fetal Working Group of the A (2018) Fetal hemodynamic response to aortic valvuloplasty and postnatal outcome: a European multicenter study. Ultrasound Obstet Gynecol. 52:221–229

    CAS  PubMed  Google Scholar 

  15. Gardiner HM, Kovacevic A, Tulzer G, Sarkola T, Herberg U, Dangel J, Ohman A, Bartrons J, Carvalho JS, Jicinska H, Fesslova V, Averiss I, Mellander M and Fetal Working Group of the A (2016) Natural history of 107 cases of fetal aortic stenosis from a European multicenter retrospective study. Ultrasound Obstet Gynecol 48:373–381

    CAS  PubMed  Google Scholar 

  16. Arzt W, Wertaschnigg D, Veit I, Klement F, Gitter R, Tulzer G (2011) Intrauterine aortic valvuloplasty in fetuses with critical aortic stenosis: experience and results of 24 procedures. Ultrasound Obstet Gynecol. 37:689–695

    CAS  PubMed  Google Scholar 

  17. Moon-Grady AJ, Morris SA, Belfort M, Chmait R, Dangel J, Devlieger R, Emery S, Frommelt M, Galindo A, Gelehrter S, Gembruch U, Grinenco S, Habli M, Herberg U, Jaeggi E, Kilby M, Kontopoulos E, Marantz P, Miller O, Otano L, Pedra C, Pedra S, Pruetz J, Quintero R, Ryan G, Sharland G, Simpson J, Vlastos E, Tworetzky W, Wilkins-Haug L, Oepkes D and International Fetal Cardiac Intervention R (2015) International fetal cardiac intervention registry: a worldwide collaborative description and preliminary outcomes. J Am Coll Cardiol. 66:388–399

    PubMed  Google Scholar 

  18. Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC Sr, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J, American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Y, Council on Clinical Cardiology CoCS, Anesthesia, Council on C, and Stroke N (2014) Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 129:2183–2242

    PubMed  Google Scholar 

  19. McElhinney DB, Marshall AC, Wilkins-Haug LE, Brown DW, Benson CB, Silva V, Marx GR, Mizrahi-Arnaud A, Lock JE, Tworetzky W (2009) Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome. Circulation 120:1482–1490

    PubMed  PubMed Central  Google Scholar 

  20. Tuo G, Khambadkone S, Tann O, Kostolny M, Derrick G, Tsang V, Sullivan I, Marek J (2013) Obstructive left heart disease in neonates with a "borderline" left ventricle: diagnostic challenges to choosing the best outcome. Pediatr Cardiol. 34:1567–1576

    PubMed  Google Scholar 

  21. Hickey EJ, Caldarone CA, Blackstone EH, Lofland GK, Yeh T Jr, Pizarro C, Tchervenkov CI, Pigula F, Overman DM, Jacobs ML, McCrindle BW and Congenital Heart Surgeons S (2007) Critical left ventricular outflow tract obstruction: the disproportionate impact of biventricular repair in borderline cases. J Thorac Cardiovasc Surg. 134:1429–1436. ( discussion 1436–7)

    PubMed  Google Scholar 

  22. Barry OM, Friedman KG, Bergersen L, Emani S, Moeyersoms A, Tworetzky W, Marshall AC, Lock JE (2018) Clinical and hemodynamic results after conversion from single to biventricular circulation after fetal aortic stenosis intervention. Am J Cardiol. 122:511–516

    PubMed  Google Scholar 

  23. Rychik J, Rome JJ, Collins MH, DeCampli WM, Spray TL (1999) The hypoplastic left heart syndrome with intact atrial septum: atrial morphology, pulmonary vascular histopathology and outcome. J Am Coll Cardiol. 34:554–560

    CAS  PubMed  Google Scholar 

  24. Vlahos AP, Lock JE, McElhinney DB, van der Velde ME (2004) Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: outcome after neonatal transcatheter atrial septostomy. Circulation 109:2326–2330

    PubMed  Google Scholar 

  25. Taketazu M, Barrea C, Smallhorn JF, Wilson GJ, Hornberger LK (2004) Intrauterine pulmonary venous flow and restrictive foramen ovale in fetal hypoplastic left heart syndrome. J Am Coll Cardiol. 43:1902–1907

    PubMed  Google Scholar 

  26. Marshall AC, Levine J, Morash D, Silva V, Lock JE, Benson CB, Wilkins-Haug LE, McElhinney DB, Tworetzky W (2008) Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome. Prenat Diagn. 28:1023–1028

    PubMed  Google Scholar 

  27. Schmidt M, Jaeggi E, Ryan G, Hyldebrandt J, Lilly J, Peirone A, Benson L, Chaturvedi RR (2008) Percutaneous ultrasound-guided stenting of the atrial septum in fetal sheep. Ultrasound Obstet Gynecol 32:923–928

    CAS  PubMed  Google Scholar 

  28. Chaturvedi RR, Ryan G, Seed M, van Arsdell G, Jaeggi ET (2013) Fetal stenting of the atrial septum: technique and initial results in cardiac lesions with left atrial hypertension. Int J Cardiol 168:2029–2036

    PubMed  Google Scholar 

  29. Kalish BT, Tworetzky W, Benson CB, Wilkins-Haug L, Mizrahi-Arnaud A, McElhinney DB, Lock JE, Marshall AC (2014) Technical challenges of atrial septal stent placement in fetuses with hypoplastic left heart syndrome and intact atrial septum. Catheter Cardiovasc Interv 84:77–85

    PubMed  Google Scholar 

  30. Michelfelder E, Gomez C, Border W, Gottliebson W, Franklin C (2005) Predictive value of fetal pulmonary venous flow patterns in identifying the need for atrial septoplasty in the newborn with hypoplastic left ventricle. Circulation 112:2974–2979

    PubMed  Google Scholar 

  31. Divanovic A, Hor K, Cnota J, Hirsch R, Kinsel-Ziter M, Michelfelder E (2011) Prediction and perinatal management of severely restrictive atrial septum in fetuses with critical left heart obstruction: clinical experience using pulmonary venous Doppler analysis. J Thorac Cardiovasc Surg 141:988–994

    PubMed  Google Scholar 

  32. Jantzen DW, Moon-Grady AJ, Morris SA, Armstrong AK, Berg C, Dangel J, Fifer CG, Frommelt M, Gembruch U, Herberg U, Jaeggi E, Kontopoulos EV, Marshall AC, Miller O, Oberhoffer R, Oepkes D, Pedra CA, Pedra SR, Peralta F, Quintero RA, Ryan G, Gelehrter SK (2017) Hypoplastic left heart syndrome with intact or restrictive atrial septum: a report from the international fetal cardiac intervention registry. Circulation 136:1346–1349

    PubMed  Google Scholar 

  33. Soongswang J, Adatia I, Newman C, Smallhorn JF, Williams WG, Freedom RM (1998) Mortality in potential arterial switch candidates with transposition of the great arteries. J Am Coll Cardiol 32:753–757

    CAS  PubMed  Google Scholar 

  34. Mawad W, Chaturvedi RR, Ryan G, Jaeggi E (2018) Percutaneous fetal atrial balloon septoplasty for simple transposition of the great arteries with an intact atrial septum. Can J Cardiol 34(342):e9–342

    Google Scholar 

  35. Dyamenahalli U, McCrindle BW, McDonald C, Trivedi KR, Smallhorn JF, Benson LN, Coles J, Williams WG, Freedom RM (2004) Pulmonary atresia with intact ventricular septum: management of, and outcomes for, a cohort of 210 consecutive patients. Cardiol Young. 14:299–308

    PubMed  Google Scholar 

  36. Wright LK, Knight JH, Thomas AS, Oster ME, St Louis JD, Kochilas LK (2019) Long-term outcomes after intervention for pulmonary atresia with intact ventricular septum. Heart 105:1007–1013

    PubMed  Google Scholar 

  37. Daubeney PE, Sharland GK, Cook AC, Keeton BR, Anderson RH, Webber SA (1998) Pulmonary atresia with intact ventricular septum: impact of fetal echocardiography on incidence at birth and postnatal outcome. UK and eire collaborative study of pulmonary atresia with intact ventricular septum. Circulation 98:562–566

    CAS  PubMed  Google Scholar 

  38. Ovaert C, Qureshi SA, Rosenthal E, Baker EJ, Tynan M (1998) Growth of the right ventricle after successful transcatheter pulmonary valvotomy in neonates and infants with pulmonary atresia and intact ventricular septum. J Thorac Cardiovasc Surg. 115:1055–1062

    CAS  PubMed  Google Scholar 

  39. Mishima A, Asano M, Sasaki S, Yamamoto S, Saito T, Ukai T, Suzuki Y, Manabe T (2000) Long-term outcome for right heart function after biventricular repair of pulmonary atresia and intact ventricular septum. Jpn J Thorac Cardiovasc Surg. 48:145–152

    CAS  PubMed  Google Scholar 

  40. Humpl T, Soderberg B, McCrindle BW, Nykanen DG, Freedom RM, Williams WG, Benson LN (2003) Percutaneous balloon valvotomy in pulmonary atresia with intact ventricular septum: impact on patient care. Circulation 108:826–832

    PubMed  Google Scholar 

  41. Roman KS, Fouron JC, Nii M, Smallhorn JF, Chaturvedi R, Jaeggi ET (2007) Determinants of outcome in fetal pulmonary valve stenosis or atresia with intact ventricular septum. Am J Cardiol. 99:699–703

    PubMed  Google Scholar 

  42. Salvin JW, McElhinney DB, Colan SD, Gauvreau K, del Nido PJ, Jenkins KJ, Lock JE, Tworetzky W (2006) Fetal tricuspid valve size and growth as predictors of outcome in pulmonary atresia with intact ventricular septum. Pediatrics 118:e415–e420

    PubMed  Google Scholar 

  43. Gardiner HM, Belmar C, Tulzer G, Barlow A, Pasquini L, Carvalho JS, Daubeney PE, Rigby ML, Gordon F, Kulinskaya E, Franklin RC (2008) Morphologic and functional predictors of eventual circulation in the fetus with pulmonary atresia or critical pulmonary stenosis with intact septum. J Am Coll Cardiol. 51:1299–1308

    PubMed  Google Scholar 

  44. Tworetzky W, McElhinney DB, Marx GR, Benson CB, Brusseau R, Morash D, Wilkins-Haug LE, Lock JE, Marshall AC (2009) In utero valvuloplasty for pulmonary atresia with hypoplastic right ventricle: techniques and outcomes. Pediatrics 124:e510–e518

    PubMed  PubMed Central  Google Scholar 

  45. Tulzer A, Arzt W, Gitter R, Prandstetter C, Grohmann E, Mair R, Tulzer G (2018) Immediate effects and outcome of in-utero pulmonary valvuloplasty in fetuses with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis. Ultrasound Obstet Gynecol. 52:230–237

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Moon-Grady AJ, Baschat A, Cass D, Choolani M, Copel JA, Crombleholme TM, Deprest J, Emery SP, Evans MI, Luks FI, Norton ME, Ryan G, Tsao K, Welch R, Harrison M (2017) Fetal treatment 2017: the evolution of fetal therapy centers—a joint opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American fetal therapy network (NAFTNet). Fetal Diagn Ther. 42:241–248

    PubMed  PubMed Central  Google Scholar 

  47. AlRefai A, Drake J, Kulkarni AV, Connor KL, Shannon P, Toi A, Chitayat D, Blaser S, Church PT, Abbasi N, Ryan G, Van Mieghem T (2019) Fetal myelomeningocele surgery: only treating the tip of the iceberg. Prenat Diagn. 39:10–15

    PubMed  Google Scholar 

  48. Luft HSBJ, Enthoven AC (1979) Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301:1364–1369

    CAS  PubMed  Google Scholar 

  49. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127

    CAS  PubMed  Google Scholar 

  50. Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 364:2128–2137

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Jenkins KJ, Newburger JW, Lock JE, Davis RB, Coffman GA, Iezzoni LI (1995) In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 95:323–330

    CAS  PubMed  Google Scholar 

  52. Hannan EL, Racz M, Kavey RE, Quaegebeur JM, Williams R (1998) Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 101:963–969

    CAS  PubMed  Google Scholar 

  53. Jenkins KJ, Gauvreau K (2002) Center-specific differences in mortality: preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. J Thorac Cardiovasc Surg. 124:97–104

    PubMed  Google Scholar 

  54. Chang RK, Klitzner TS (2002) Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 109:173–181

    PubMed  Google Scholar 

  55. Allen SW, Gauvreau K, Bloom BT, Jenkins KJ (2003) Evidence-based referral results in significantly reduced mortality after congenital heart surgery. Pediatrics 112:24–28

    PubMed  Google Scholar 

  56. Bazzani LG, Marcin JP (2007) Case volume and mortality in pediatric cardiac surgery patients in California, 1998–2003. Circulation 115:2652–2659

    PubMed  Google Scholar 

  57. Hirsch JC, Gurney JG, Donohue JE, Gebremariam A, Bove EL, Ohye RG (2008) Hospital mortality for Norwood and arterial switch operations as a function of institutional volume. Pediatr Cardiol 29:713–717

    PubMed  Google Scholar 

  58. Welke KF, O'Brien SM, Peterson ED, Ungerleider RM, Jacobs ML, Jacobs JP (2009) The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database. J Thorac Cardiovasc Surg 137:1133–1140

    PubMed  Google Scholar 

  59. Davies RR, Russo MJ, Hong KN, Mital S, Mosca RS, Quaegebeur JM, Chen JM (2011) Increased short- and long-term mortality at low-volume pediatric heart transplant centers: should minimum standards be set? Retrospective data analysis. Ann Surg 253:393–401

    PubMed  Google Scholar 

  60. Pasquali SK, Jacobs JP, He X, Hornik CP, Jaquiss RD, Jacobs ML, O'Brien SM, Peterson ED, Li JS (2012) The complex relationship between center volume and outcome in patients undergoing the Norwood operation. Ann Thorac Surg. 93:1556–1562

    PubMed  Google Scholar 

  61. Pasquali SK, Li JS, Burstein DS, Sheng S, O'Brien SM, Jacobs ML, Jaquiss RD, Peterson ED, Gaynor JW, Jacobs JP (2012) Association of center volume with mortality and complications in pediatric heart surgery. Pediatrics 129:e370–e376

    PubMed  PubMed Central  Google Scholar 

  62. Pasquali SK, He X, Jacobs JP, Jacobs ML, O’Brien SM, Gaynor JW (2012) Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of the STS congenital heart surgery database. Ann Thorac Surg 94:573–579. (discussion 579–80)

    PubMed  Google Scholar 

  63. Hornik CP, He X, Jacobs JP, Li JS, Jaquiss RD, Jacobs ML, O'Brien SM, Welke K, Peterson ED, Pasquali SK (2012) Relative impact of surgeon and center volume on early mortality after the Norwood operation. Ann Thorac Surg 93:1992–1997

    PubMed  PubMed Central  Google Scholar 

  64. Sakai-Bizmark R, Mena LA, Kumamaru H, Kawachi I, Marr EH, Webber EJ, Seo HH, Friedlander SIM, Chang RR (2019) Impact of pediatric cardiac surgery regionalization on health care utilization and mortality. Health Serv Res. 54:890–901

    PubMed  Google Scholar 

  65. Lindenburg IT, Wolterbeek R, Oepkes D, Klumper FJ, Vandenbussche FP, van Kamp IL (2011) Quality control for intravascular intrauterine transfusion using cumulative sum (CUSUM) analysis for the monitoring of individual performance. Fetal Diagn Ther. 29:307–314

    PubMed  Google Scholar 

  66. Morris RK, Selman TJ, Harbidge A, Martin WI, Kilby MD (2010) Fetoscopic laser coagulation for severe twin-to-twin transfusion syndrome: factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres. BJOG 117:1350–1357

    CAS  PubMed  Google Scholar 

  67. Edwards AG, Teoh M, Hodges RJ, Palma-Dias R, Cole SA, Fung AM, Walker SP (2016) Balancing dion? Twin Res Hum Genet. 19:276–284

    PubMed  Google Scholar 

  68. Jaeggi E, Chaturvedi RR (2018) Intervention for fetal critical aortic stenosis: first step in a metamorphosis? Ultrasound Obstet Gynecol. 52:151–152

    CAS  PubMed  Google Scholar 

  69. Tchirikov M, Zhumadilov ZS, Bapayeva G, Bergner M, Entezami M (2017) The effect of intraumbilical fetal nutrition via a subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses. J Perinat Med. 45:227–236

    CAS  PubMed  Google Scholar 

  70. Partridge EA, Davey MG, Hornick MA, McGovern PE, Mejaddam AY, Vrecenak JD, Mesas-Burgos C, Olive A, Caskey RC, Weiland TR, Han J, Schupper AJ, Connelly JT, Dysart KC, Rychik J, Hedrick HL, Peranteau WH, Flake AW (2017) Corrigendum: an extra-uterine system to physiologically support the extreme premature lamb. Nat Commun 8:15794

    CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Rajiv R. Chaturvedi is supported by the Ted Rogers Centre for Heart Research.

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  1. Sok-Leng Kang and Edgar Jaeggi are joint first authors.

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  1. Division of Cardiology, Labatt Heart Centre, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada

    Sok-Leng Kang, Edgar Jaeggi & Rajiv R. Chaturvedi

  2. Fetal Medicine Unit, Department of Obstetrics and Gynecology, Mt Sinai Hospital, Toronto, ON, M5G 1X5, Canada

    Greg Ryan & Rajiv R. Chaturvedi

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Kang, SL., Jaeggi, E., Ryan, G. et al. An Overview of Contemporary Outcomes in Fetal Cardiac Intervention: A Case for High-Volume Superspecialization?. Pediatr Cardiol 41, 479–485 (2020). https://doi.org/10.1007/s00246-020-02294-2

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