Fetal Surgery for Congenital Heart Diseases: A Systematic Review and Single-Arm Meta-analysis.

INTRODUCTION

Congenital heart diseases (CHD) are the most common congenital anomalies, and fetal cardiac interventions (FCI) have been developed to improve perinatal outcomes. We aimed to conduct a systematic review and meta-analysis of observational studies to evaluate the effects of FCI on CHD.

METHODS

We searched PubMed/Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to April 2025 without language restrictions. References of included studies and prior reviews were also screened. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; ID CRD42024599628). Eligible studies included observational cohorts evaluating intrauterine procedures for CHD. Data were synthesized using random effects models in RStudio (version 4.2.2), and study quality was assessed with the Newcastle-Ottawa Quality Assessment Form for Cohort Studies (NOS).

RESULTS

Twelve studies including 485 fetuses with CHD were analyzed. The pooled overall survival rate after fetal cardiac intervention was 57.4% (95% confidence interval [CI] 39.8-73.3), with survival ranging from 20.0% to 90.2% across studies. The pooled perinatal mortality rate was 31.5% (95% CI 21.0-44.2), with estimates ranging from 9.8% to 66.7%. Substantial heterogeneity was observed for both outcomes (I2 > 75%).

CONCLUSION

FCI for CHD are associated with moderate overall survival but substantial perinatal mortality. Standardized protocols, refined patient selection, and multicenter collaboration are needed to improve outcomes and guide clinical decision-making.