In what is said to be a first – doctors at Children’s Hospital Colorado (Children’s Colorado) have completed the first-ever EXIT (Ex Utero Intrapartum Treatment) to ventricular pacing procedure. The 36-week fetus suffered from complete atrioventricular block (CAVB) and cardiac dysfunction and was at high risk of dying before delivery. The baby received a temporary pacemaker while still attached to its mother via the umbilical cord, which ensured enough blood flow from the heart to the rest of its body for delivery.
“In essence, this procedure gave the fetus the gift of time,” said Bettina Cuneo, MD, fetal cardiologist. “Not only were we able to expose the heart and attach the pacing leads to make the heart rate faster, we were able to make sure the heart was functioning effectively before cutting the umbilical cord.”
A team of experts led by Dr. Cuneo and Henry Galan, MD, maternal fetal medicine at the hospital’s Colorado Fetal Care Center, worked with a multi-disciplinary team including Max Mitchell, MD, cardiothoracic surgery, to perform the procedure, and the infant was successfully delivered. Their research was recently published in Fetal Diagnosis and Therapy.
Their approach is expected to significantly lower the mortality rates for preterm babies born with these conditions.
“With the mother’s body acting as a heart and lung bypass machine, the EXIT procedure allows life-saving fetal interventions while maintaining in-utero circulation,” said Dr. Galan. “Although careful selection of patients is necessary, this ‘rescue’ pacing not only provides an option for the most fragile patients with CAVB, but also for fetuses who are at high risk for in-utero loss of life but are too premature for delivery.”