Fetal Endoscopic Tracheal Occlusion (FETO) Trial for Congenital Diaphragmatic Hernia (CDH)

Study Overview
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Brief Summary
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This is a single site pilot trial to assess the feasibility and safety of treating severe CDH with Fetal Endoscopic Tracheal Occlusion with the Goldballoon Detachable Balloon (GOLDBAL2) along with the Delivery Microcatheter (BALTACCI-BDPE100) at Michigan Medicine. The study will enroll pregnant women that meet study criteria. Participants will have placement of FETO between gestational age at 27 weeks plus 0 days and 29 weeks 6 days. The timing for removal of FETO will ideally be between 34 weeks 0 days and 34 weeks and 6 days but ultimately decided by the Fetal Diagnosis and Treatment Center at Michigan Medicine. This study requires that study participants live within 30 miles of the Von Voigtlander Women's Hospital and C.S. Mott Children's Hospital in order to maintain weekly follow up appointments while the balloon is in place and up to delivery. Additionally, there are lifestyle considerations where participants would be unable to carry on normal daily activities including exercise and sexual intercourse, not be able to work the remainder of the pregnancy, as well as have a support person that is available to stay with such as a spouse, friend, partner, parent.

Official Title
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Fetal Endoscopic Tracheal Occlusion Trial for Congenital Diaphragmatic Hernia (CDH)

Conditions
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Congenital Diaphragmatic Hernia

Intervention / Treatment
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* Device: FETO with Goldballoon Detachable Balloon (GOLDBAL2) along with the Delivery Microcatheter (BALTACCI-BDPE100)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed and dated consent Stated willingness to comply with all study procedures and availability for the duration of the study Singleton pregnancy No pathogenic variants on microarray or pathologic findings on karyotype Fetal echocardiogram with changes expected with CDH and no major structural cardiac defects Fetal CDH (left or right) with severe pulmonary hypoplasia, defined as observed-to-expected (o/e) lung to head ratios (LHR) <25% with liver up Gestational age at FETO procedure: if o/e LHR <25% will be done at 27 weeks plus 0 days to 29 weeks plus 6 days Meets psychosocial criteria Willing to reside within 30 minutes of Von Voigtlander Women's Hospital and ability to maintain follow up appointments Patient has a support person (e.g. spouse, partner, friend, parent) that is available to stay with her for the duration of the pregnancy near Von Voigtlander Women's Hospital Willing to comply with restrictions of daily living including inability to exercise, have intercourse, or return to work. Exclusion Criteria: Multi-fetal pregnancy History of latex allergy History of preterm labor or incompetent cervix (requiring cerclage), short cervix (≤20mm), or uterine anomaly predisposing to preterm labor Bilateral CDH, unilateral CDH with o/e LHR > 25%, or unilateral CDH with o/e LHR <25% but liver completely down in abdomen Additional fetal or genetic abnormalities that would impact care after delivery or be known to have an impact on outcome Maternal contraindications to elective fetoscopic surgery Significant placental abnormalities (abruption, chorioangioma, accreta) known at time of enrollment and/or surgery Maternal isoimmunization or neonatal alloimmune thrombocytopenia Maternal HIV, Hepatitis B with positive surface antigen, Hepatitis C with presence of virus in maternal blood due to risk of fetal transmission during the procedure No safe or feasible fetoscopic approach to balloon placement Social work will meet with each patient to evaluate the social situation and support system. Identifiable issues of social instability or compliance with the protocol will exclude her as a potential candidate.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: FETO with GOLDBAL2<br>A balloon will be placed in the airway of the fetus during the FETO procedure. | Device: FETO with Goldballoon Detachable Balloon (GOLDBAL2) along with the Delivery Microcatheter (BALTACCI-BDPE100)<br>* This will take place between gestation of 27w0d - 29w6d. The balloon will be removed at approximately 34 weeks gestation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of successful placements of the Goldballoon Detachable Balloon (GOLDBAL2) at gestational age 27 weeks zero days (27w0d) to 29 weeks and 6 days (29w6d) gestation. | Success will be defined as completion with direct visual placement above the carina and confirmation on ultrasound done during the procedure. | 27w0d - 29w6d | 
| Number of successful retrievals of the GOLDBAL2 | This will ideally occur around the 34th week of gestation and have the balloon removed prior to delivery. | Removal prior to delivery approximately 34 weeks of gestation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in observed to expected total fetal lung to head ratios (o/e TFLV) on prenatal magnetic resonance imaging (MRI) | Fetal MRI done prior to balloon placement and again done at approximately 2 weeks of balloon retrieval. | baseline (prior to balloon placement), approximately 2 weeks after balloon retrieval | 
| Change in fetal lung growth | Fetal ultrasounds will be done weekly while the balloon is in place. Fetal lung growth will be calculated as the difference between the o/e LHR pre-balloon placement and the o/e LHR immediately prior to balloon removal. | baseline (before balloon placement), immediately prior to balloon retrieval | 
| Gestational age at delivery |  | At the time of delivery (up to approximately 34 weeks) | 
| Survival of infant to hospital discharge or 180 days after hospitalized | This will be measured after the infant is delivered to hospital discharge or analyzed for survival at 180 days for those still hospitalized at that time point. | Discharge from hospital or up to 180 days in the hospital | 
| Number of maternal complications | Complications during pregnancy, and/or at delivery and follow-up to include; preterm labor, premature rupture of membranes (PROM), Preterm Premature Rupture of Membranes (PPROM), oligohydramnios, polyhydramnios, placental abruption, chorioamniotic separation, chorioamnionitis, and other infection. | up to 4-6 weeks postpartum | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pregnant, fetal endoscopic tracheal occlusion