{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:28:41Z","timestamp":1787077721137,"version":"build-2736575974"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The relationship between fetal aortic valvuloplasty procedural volume and outcomes is crucial to understand whether regionalization should be advised worldwide. This study utilizes the International Fetal Cardiac Intervention Registry to examine the relationship between center volume for fetal aortic valvuloplasty and outcome metrics including procedure success, complications, and fetal death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Data were included from institutions performing \u22653 procedures (2001\u20132018). The primary outcome was technical success, defined as \u22651 balloon inflation across the aortic valve, with increased antegrade flow across the valve, new aortic regurgitation, or both. Secondary end points were procedural complications and fetal periprocedural death (within 48 hours). Univariable and Classification and Regression Tree analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Eleven centers, with volumes ranging from 6 to 31 cases, performed 162 fetal aortic valvuloplasties with a technical success rate of 80.2%. Higher volume was not associated with better technical success or fewer complications but was associated with fewer periprocedural fetal deaths. Employing Classification and Regression Tree modeling, the largest drivers of improved outcomes for all measures were greater estimated fetal weight and gestational age. A single cardiac puncture was associated with greater technical success and fewer procedural complications after accounting for fetal estimated fetal weight and gestational age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In this registry cohort, higher-volume centers did not have greater fetal aortic valvuloplasty technical success or fewer complications but did have fewer periprocedural fetal deaths. Fetal gestational age and number of cardiac punctures influenced outcomes, suggesting that unmeasured fetal selection criteria, such as different referral patterns, and technical expertise, indicative of overall center\/team experience, may influence fetal survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.125.015593","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:01:26Z","timestamp":1780995686000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Technical Success of Fetal Aortic Valvuloplasty in Relation to Center Volumes: A Report From the International Fetal Cardiac Intervention Registry"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5345-5701","authenticated-orcid":true,"given":"Manon","family":"Gijtenbeek","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Leiden University Medical Center, the Netherlands (M.G., M.C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8056-0934","authenticated-orcid":true,"given":"Shaine A.","family":"Morris","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX (S.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9386-0258","authenticated-orcid":true,"given":"Ulrike","family":"Herberg","sequence":"additional","affiliation":[{"name":"Pediatric Heart Center, Department of Pediatric Cardiology, University of Bonn, Germany (U.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Grinenco","sequence":"additional","affiliation":[{"name":"Hospital Italiano de Buenos Aires, Argentina (S.G., P.M.*, L.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Marantz","sequence":"additional","affiliation":[{"name":"Hospital Italiano de Buenos Aires, Argentina (S.G., P.M.*, L.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0172-1304","authenticated-orcid":true,"given":"Lucas","family":"Ota\u00f1o","sequence":"additional","affiliation":[{"name":"Hospital Italiano de Buenos Aires, Argentina (S.G., P.M.*, L.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6815-6771","authenticated-orcid":true,"given":"Sarah K.","family":"Gelehrter","sequence":"additional","affiliation":[{"name":"C.S. Mott Children\u2019s Hospital, Ann Arbor, MI (S.K.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1308-1474","authenticated-orcid":true,"given":"Alberto","family":"Galindo","sequence":"additional","affiliation":[{"name":"Hospital Universitario 12 de Octubre, Madrid, Spain (A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9527-3671","authenticated-orcid":true,"given":"Sophie","family":"Malekzadeh-Milani","sequence":"additional","affiliation":[{"name":"Necker Hospital For Sick Children, Paris, France (S.M.-M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9155-4572","authenticated-orcid":true,"given":"Joanna H.","family":"Dangel","sequence":"additional","affiliation":[{"name":"Medical University of Warsaw, Poland (J.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6807-3578","authenticated-orcid":true,"given":"Monica","family":"Cruz-Lemini","sequence":"additional","affiliation":[{"name":"Women and Perinatal Health Research Group, Institut de Recerca (IR SANT PAU), Barcelona, Spain (M.C.-L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9012-6592","authenticated-orcid":true,"given":"Edgar T.","family":"Jaeggi","sequence":"additional","affiliation":[{"name":"Hospital for Sick Children, Toronto, Ontario, Canada (E.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone R.","family":"Pedra","sequence":"additional","affiliation":[{"name":"Hospital do Coracao, Sao Paulo, Brazil (S.R.P., C.P., F.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.C.","family":"Pedra","sequence":"additional","affiliation":[{"name":"Hospital do Coracao, Sao Paulo, Brazil (S.R.P., C.P., F.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7279-5311","authenticated-orcid":true,"given":"Fabio","family":"Peralta","sequence":"additional","affiliation":[{"name":"Hospital do Coracao, Sao Paulo, Brazil (S.R.P., C.P., F.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9773-7441","authenticated-orcid":true,"given":"John","family":"Simpson","sequence":"additional","affiliation":[{"name":"Evelina London Children\u2019s Hospital, Guy\u2019s &amp; St Thomas\u2019 NHS Trust, United Kingdom (J. Simpson, T.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4084-4203","authenticated-orcid":true,"given":"Trisha V.","family":"Vigneswaran","sequence":"additional","affiliation":[{"name":"Evelina London Children\u2019s Hospital, Guy\u2019s &amp; St Thomas\u2019 NHS Trust, United Kingdom (J. Simpson, T.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9436-4897","authenticated-orcid":true,"given":"Helena M.","family":"Gardiner","sequence":"additional","affiliation":[{"name":"McGovern Medical School University of Texas, Houston (H.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4534-5075","authenticated-orcid":true,"given":"Aimee K.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital, Columbus, OH (A.K.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Pruetz","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Los Angeles, CA (J.P., R.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramen","family":"Chmait","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Los Angeles, CA (J.P., R.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogelio","family":"Cruz-Martinez","sequence":"additional","affiliation":[{"name":"Fetal Medicine Mexico Institute, Guadalajara, Jalisco, Mexico and Women and Children\u2019s Specialty Hospital of Queretaro, Mexico (R.C.-M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3441-4773","authenticated-orcid":true,"given":"James","family":"Strainic","sequence":"additional","affiliation":[{"name":"UH Rainbow Babies and Children\u2019s Hospital, Cleveland, OH (J. Strainic)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0443-1997","authenticated-orcid":true,"given":"Monique C.","family":"Haak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Leiden University Medical Center, the Netherlands (M.G., M.C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3822-693X","authenticated-orcid":true,"given":"Anita J.","family":"Moon-Grady","sequence":"additional","affiliation":[{"name":"University of California San Francisco, San Francisco, CA (A.J.M.-G.). *No longer affiliated with this institution."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.65.5.256"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009032"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1159\/000460247"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(00)00733-5"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.870246"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.848994"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.05.037"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17530"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15876"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14885"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18913"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.05.020"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2005.08.047"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951109990382"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.06.022"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.28846"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2023.03.050"},{"key":"e_1_3_3_19_2","first-page":"13","volume-title":"Callen\u2019s Ultrasonography in Obstetrics and Gynecology","author":"Colan S","year":"2017","unstructured":"Colan S. Appendix F: normal echocardiographic values for fetal cardiovascular structures. In: Norton ME, Scoutt L, Feldstein\u2019 V, Vickie A, editors. Callen\u2019s Ultrasonography in Obstetrics and Gynecology. Elsevier; 2017:13\u201317."},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.84.1.59"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.100835"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1159\/000527121"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.125.015209"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1159\/000502840"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15867"}],"container-title":["Circulation: Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCINTERVENTIONS.125.015593","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:00:25Z","timestamp":1787076025000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCINTERVENTIONS.125.015593"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":24,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1161\/CIRCINTERVENTIONS.125.015593"],"URL":"https:\/\/doi.org\/10.1161\/circinterventions.125.015593","relation":{},"ISSN":["1941-7640","1941-7632"],"issn-type":[{"value":"1941-7640","type":"print"},{"value":"1941-7632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2025-05-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}