Supplementary Material for: THE MANAGEMENT OF ACARDIAC TWINNING - TRAP SEQUENCE: AN INTERNATIONAL SURVEY

Introduction: The optimal approach and therapy method for the acardiac twin with a reverse arterial perfusion sequence has not yet been established. The aim of this study is to determine the clinical practice patterns amongst international fetal therapy units in their management of these cases. Methods: A survey was sent to fetal centers across the world via email between December 2020 and December 2021. Results: Responses were obtained from 77% contacted centers. The most frequent ultrasound variables used in the evaluation of TRAP sequence include echocardiographic assessment of the pump twin and umbilical artery Doppler waveforms in the acardiac and pump twins, in 90% and 80% of the centers respectively. Most centers in Europe and Latin America propose an in-utero intervention in all cases. Most centers in Europe and Latin America prefer interstitial laser ablation, whereas radiofrequency ablation is preferred in North America. The earliest gestational age for an intervention is on mean 13 weeks in Europe, which is earlier than the other geographic areas (p = 0.001). Conclusions: Most centers agreed that antenatal evaluation should include echocardiography along with the UA Doppler waveform measurements, and the most frequently used interventions were interstitial laser ablation or RFA at a median between 14 to 26 weeks.

引言：针对合并反向动脉灌注序列（twin reversed arterial perfusion, TRAP）的无心双胎，目前尚未确立最优诊疗方案。本研究旨在明确全球各胎儿治疗中心针对此类病例的临床诊疗实践模式。
方法：本研究于2020年12月至2021年12月期间，通过电子邮件向全球各地的胎儿医学中心发放调查问卷。
结果：本次调查共回收77%被联络胎儿中心的有效回复。用于评估TRAP序列的最常用超声指标包括供血双胎（pump twin）的超声心动图评估，以及无心双胎与供血双胎的脐动脉（umbilical artery）多普勒波形检测，分别有90%和80%的中心采用此类检测手段。欧洲与拉丁美洲的多数中心主张对所有此类病例实施宫内干预。欧洲与拉丁美洲的多数中心偏好采用间质激光消融术（interstitial laser ablation），而北美中心则更倾向于射频消融术（radiofrequency ablation, RFA）。欧洲中心实施干预的最早平均孕周为13周，早于其他地理区域（p=0.001）。
结论：多数中心认为产前评估应包含超声心动图检查与脐动脉多普勒波形检测，临床最常用的干预手段为间质激光消融术或射频消融术，干预时机的中位孕周为14至26周。