TOTAL Trial: FETO improves survival of severe congenital diaphragmatic hernia

Topic overview

Randomized trial demonstrates fetoscopic tracheal occlusion (FETO) at 27-29 weeks significantly improves survival in severe left-sided congenital diaphragmatic hernia (40% vs 15% in expectant care). Procedure increases risk of preterm rupture of membranes and preterm birth, with rare complications from balloon placement/removal.

Key takeaways

FETO at 27-29 weeks doubled survival to discharge in severe left CDH (40% vs 15%, RR 2.67, p=0.009)
Survival benefit persisted to 6 months with no additional deaths after NICU discharge
FETO increased preterm PROM risk 4-fold (47% vs 11%) and preterm birth risk 2.6-fold (75% vs 29%)
Trial stopped early for efficacy after third interim analysis with 80 patients enrolled
Two procedure-related neonatal deaths occurred: one from placental laceration, one from failed balloon removal

Keywords

Congenital Diaphragmatic Hernia Fetoscopic Tracheal Occlusion Feto Fetal Surgery Pulmonary Hypoplasia Prenatal Intervention Randomized Controlled Trial

Hashtags

#FetalSurgery #CongenitalDiaphragmaticHernia #FETO #PrenatalIntervention

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