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Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus

Published online by Cambridge University Press:  05 August 2020

Chen Wei ,
Steven Staffa ,
David Zurakowski ,
Susan Saleeb ,
Francis Fynn-Thompson  and
Sitaram M. Emani Open the ORCID record for Sitaram M. Emani [Opens in a new window]
Chen Wei
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Steven Staffa
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
David Zurakowski
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Susan Saleeb
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Francis Fynn-Thompson
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Sitaram M. Emani*
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Sitaram M. Emani, MD, Department of Cardiac Surgery, Boston Children’s Hospital, 300 Longwood Ave, Bader 273, Boston, MA 02115, USA. E-mail: [email protected]
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Abstract

Background:

Patent ductus arteriosus closure is traditionally performed by thoracotomy approach. Video-assisted thoracoscopic surgery is a less frequently utilised alternative. We sought to compare elective surgical outcomes between the two methods via a single-centre retrospective cohort analysis.

Methods:

All patients >3.2 kg undergoing surgical patent ductus arteriosus ligation at a single institution from 2000 to 2018 were retrospectively reviewed. Propensity matching for age, weight, diuretic usage, and preterm status was conducted to adjust for differences in baseline patient characteristics. Outcome measures included operative time, hospitalisation duration, post-operative complications, and re-operation.

Results:

A total of 173 patients were included, 127 thoracoscopy and 46 thoracotomy. In the unmatched cohorts, no significant difference in closure success was found (94% thoracoscopy versus 100% thoracotomy, p = 0.192). Although median operative time was longer for thoracoscopy (87 versus 56 minutes, p < 0.001), hospitalisation duration was shorter (1.05 versus 2.41 days, p < 0.001), as was ICU stay (0.00 versus 0.75 days, p < 0.001). There were no significant differences in re-operation or complication rates, except chest tube placement (11% thoracoscopy versus 50% thoracotomy, p < 0.001). After matching (69 thoracoscopy versus 20 thoracotomy), these differences persisted, including median operative time (81 versus 56 minutes, p = 0.007; thoracoscopy versus thoracotomy), hospitalisation duration (1.25 versus 2.27 days, p < 0.001), and chest tube placement (17% versus 60%, p < 0.001). There remained no significant difference in complications or re-operations.

Conclusions:

Thoracoscopic ligation was associated with shorter ICU and hospital stays and less frequent chest tube placement, but longer operative times. Other risks, including bleeding, chylothorax, and recurrent laryngeal nerve injury, were similar.

Keywords

patent ductus arteriosus ligationvideo-assisted thoracoscopic surgeryminimally invasive surgery
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1433 - 1438
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e143–e263.CrossRefGoogle Scholar
Laborde, F. Video-thoracoscopic surgical interruption of patent ductus arteriosus. Routine experience in 332 pediatric cases. EurJCardio-Thoracic Surg 1997; 11: 1052–1055.Google ScholarPubMed
Villa, E, Vanden Eynden, F, Le Bret, E, Folliguet, T, Laborde, F. Paediatric video-assisted thoracoscopic clipping of patent ductus arteriosus: experience in more than 700 cases. Eur J Cardiothorac Surg 2004; 25: 387–393.CrossRefGoogle ScholarPubMed
Nezafati, MH, Soltani, G, Mottaghi, H, Horri, M, Nezafati, P. Video-assisted thoracoscopic patent ductus arteriosus closure in 2,000 patients. Asian Cardiovasc Thorac Ann 2011; 19: 393–398.CrossRefGoogle ScholarPubMed
Kennedy, AP, Snyder, CL, Ashcraft, KW, Manning, PB. Comparison of muscle-sparing thoracotomy and thoracoscopic ligation for the treatment of patent ductus arteriosus. J Pediatr Surg 1998; 33: 259–261.CrossRefGoogle ScholarPubMed
Vanamo, K, Berg, E, Kokki, H, Tikanoja, T. Video-assisted thoracoscopic vs. open surgery for persistent ductus arteriosus. J Pediatr Surg 2006; 41: 1226–1229.CrossRefGoogle Scholar
Chen, H, Weng, G, Chen, Z, et al. Comparison of posterolateral thoracotomy and video-assisted thoracoscopic clipping for the treatment of patent ductus arteriosus in neonates and infants. Pediatr Cardiol 2011; 32: 386–390.CrossRefGoogle ScholarPubMed
Esfahanizadeh, J, Aghaee Meybodi, N, Sepehri Shamloo, A, et al. Video-assisted thoracoscopic vs. open surgery for persistent ductus arteriosus: Report of 10 years’ experience. Life Sci J 2013; 10: 1068–1072.Google Scholar
Stankowski, T, Aboul-Hassan, SS, Marczak, J, Szymanska, A, Augustyn, C, Cichon, R. Minimally invasive thoracoscopic closure vs. thoracotomy in children with patent ductus arteriosus. J Surg Res 2017; 208: 1–9.CrossRefGoogle Scholar
Laborde, F, Noirhomme, P, Karam, J, Batisse, A, Bourel, P, Saint Maurice, O. A new video-assisted thoracoscopic surgical technique for interruption of patient ductus arteriosus in infants and children. J Thorac Cardiovasc Surg 1993; 105: 278–280.CrossRefGoogle ScholarPubMed
McKenna, RJ. Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin 2008; 18: 275–280.CrossRefGoogle ScholarPubMed
Hsieh, M-J, Wen, C-T, Fang, H-Y, Wen, Y-W, Lin, C-C, Chao, Y-K. Learning curve of image-guided video-assisted thoracoscopic surgery for small pulmonary nodules: a prospective analysis of 30 initial patients. J Thorac Cardiovasc Surg 2018; 155: 1825–1832.CrossRefGoogle ScholarPubMed
Herrin, MA, Zurakowski, D, Fynn-Thompson, F, Baird, CW, Del Nido, PJ, Emani, SM. Outcomes following thoracotomy or thoracoscopic vascular ring division in children and young adults. J Thorac Cardiovasc Surg 2017; 154: 607–615.CrossRefGoogle ScholarPubMed
Miles, RH, DeLeon, SY, Muraskas, J, et al. Safety of patent ductus arteriosus closure in premature infants without tube thoracostomy. Ann Thorac Surg 1995; 59: 668–670.CrossRefGoogle ScholarPubMed
Bolourian, AA. Advantages of surgical closure of patent ductus arteriosus without tube thoracostomy. Cardiovasc Surg 1999; 7: 348–350.CrossRefGoogle ScholarPubMed
Jacobs, JP, Giroud, JM, Quintessenza, JA, et al. The modern approach to patent ductus arteriosus treatment: complementary roles of video-assisted thoracoscopic surgery and interventional cardiology coil occlusion. Ann Thorac Surg 2003; 76: 1421–1427.CrossRefGoogle ScholarPubMed
Feltes, TF, Bacha, E, Beekman, RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123: 2607–2652.CrossRefGoogle ScholarPubMed
Fu, Y-C, Hwang, B, Jan, S-L, et al. Influence of ductal size on the results of transcatheter closure of patent ductus arteriosus with coils. Jpn Heart J 2003; 44(: 395–401.CrossRefGoogle ScholarPubMed
Lam, JY, Lopushinsky, SR, Ma, IWY, Dicke, F, Brindle, ME. Treatment options for pediatric patent ductus arteriosus: systematic review and meta-analysis. Chest 2015; 148: 784–793.CrossRefGoogle ScholarPubMed
Chen, H, Weng, G, Chen, Z, et al. Comparison of long-term clinical outcomes and costs between video-assisted thoracoscopic surgery and transcatheter amplatzer occlusion of the patent ductus arteriosus. Pediatr Cardiol 2012; 33: 316–321.CrossRefGoogle ScholarPubMed