Comparison of Posterolateral Thoracotomy and Video-Assisted Thoracoscopic Clipping for the Treatment of Patent Ductus Arteriosus in Neonates and Infants

Abstract

This study was designed to compare the long-term clinical outcomes and costs between video-assisted thoracic surgery (VATS) and posterolateral thoracotomy (PT) in neonates and infants. This study enrolled 302 patients with isolated patent ductus arteriosus (PDA) from January 2002 to 2007 and followed them up until April 2010. A total of 134 patients underwent total VATS (VATS group), and 168 underwent PDA closure through PT (PT group). The two groups were compared according to clinical outcomes and costs. The demographics and preoperative clinical characteristics of the patients were similar in the two groups. No cardiac deaths occurred, and the closure rate was 100% successful in both groups. The operating, recovery, and pleural fluid drainage times were significantly shorter in the VATS group than in the PT group. Statistically significant differences in length of incision, postoperative temperature, and acute procedure-related complications were observed between the two groups. The cost was $1,150.3 ± $221.2 for the VATS group and $2415.8 ± $345.2 for the PT group (P < 0.05). No cardiac deaths or newly occurring arrhythmias were detected in either group during the follow-up period. Statistically significant differences in the rate of residual shunt and scoliosis were observed between the two groups. The left ventricular end-diastolic diameter and the pulmonary artery diameter could be restored to normal in the VATS group but not in the PT group. The study confirmed that VATS offers a minimally traumatic, safe, and effective technique for PDA interruption in neonates and infants.

Treatment Options for Pediatric Patent Ductus Arteriosus

“…No patients required reintervention, but VATS had fewer complications, a lower cost, a shorter LOS, and a shorter time in the operating room . 32 Th e same authors also compared the outcomes of pediatric and adult PDAs treated either by VATS or by catheter-based therapy using the Amplatzer occluder and found that subjects undergoing VATS did not require reintervention compared with 4.1% in the catheter arm. VATS also had fewer complications and a lower cost but an increased duration of procedure and a longer LOS.…”

20-year history of thoracic surgery in Russian Federation

“…Видеоторакоскопия используется для лигирования открытого артериального протока. В последнее вре-мя пока только в западной печати появились работы по ее использованию для протезирования клапанов сердца [40][41][42][43][44].…”

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

“…[2][3][4] In addition, comparison studies of thoracoscopy versus thoracotomy have thus far demonstrated no significant global differences in safety and efficacy. [5][6][7][8][9] Nevertheless, the data comparing the two methods remain sparse and conflicted on multiple important technical indices. Some studies have indicated that thoracoscopic surgery is associated with shorter hospital stays 6,8 , reduced operative times 6,7 , and fewer post-operative complications 7,9 , while others have described either neutral or opposing findings.…”

“…[5][6][7][8][9] Nevertheless, the data comparing the two methods remain sparse and conflicted on multiple important technical indices. Some studies have indicated that thoracoscopic surgery is associated with shorter hospital stays 6,8 , reduced operative times 6,7 , and fewer post-operative complications 7,9 , while others have described either neutral or opposing findings. 6,7,9 Some studies have also focused entirely on neonate and infant patient populations, for which outcomes may be confounded by co-morbidities or clinical status requiring urgent ductus closure, or have included predominantly low-birth-weight infants.…”