Outcomes following thoracotomy or thoracoscopic vascular ring division in children and young adults

Herrin, Melissa A.; Zurakowski, David; Fynn‐Thompson, Francis; Baird, Christopher W.; Nido, Pedro J. del; Emani, Sitaram M.

doi:10.1016/j.jtcvs.2017.01.058

Cited by 33 publications

(20 citation statements)

References 19 publications

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“…To investigate postoperative complications, operation duration, and total length of hospital stay following the use of the minimally invasive VATS technique in children for the division of vascular rings, Herrin et al conducted a retrospective study of patients who underwent vascular ring division through conventional thoracotomy or minimally invasive VATS at their institution. 10 A total of 115 children (median age 2.7 years) underwent vascular ring division via VATS, while 85 patients underwent the conventional thoracotomy. VATS repairs were associated with significantly shorter operations and length of stay and improved cosmetic outcomes, as well as comparable incidence of major complications, including chylothorax and vocal cord paralysis, when compared to traditional thoracotomy.…”

Section: Vascular Ring Divisionmentioning

confidence: 99%

Borrowing from Adult Cardiac Surgeons—Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era

Alsarraj

Nellis

Vekstein

et al. 2020

Innovations�(Phila)

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The majority of congenital and adult cardiac surgery is performed through a median sternotomy. For surgeons, this incision provides excellent exposure; however, for patients, a median sternotomy confers a poorer cosmetic outcome and the possibility of postoperative respiratory dysfunction, chronic pain, and deep sternal wound infections. Despite the advances in adult cardiac surgery, the use of minimally invasive techniques in pediatric patients is largely limited to small case series and less complex repairs. In this article, we review the risks, benefits, and limitations of the minimally invasive congenital cardiac approaches being performed today. The interest in these approaches continues to grow as more data supporting reduced morbidity, decreased length of stay, and faster recovery are published. In the future, as the technology and surgical familiarity improve, these alternative approaches will become more common, and may someday become the standard of care.

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Section: Vascular Ring Divisionmentioning

confidence: 99%

Borrowing from Adult Cardiac Surgeons—Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era

Alsarraj

Nellis

Vekstein

et al. 2020

Innovations�(Phila)

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“…Furthermore, when Kommerell diverticulum excluded, they have reported only 8 cases that required re-intervention in overall 350 cases. Similarly, Herrin et al (22) reported necessity of re-invervention in 8 of total 200 cases (115 VATS and 85 thoracoscopy). Seven of these had aortopexy and only two of them were operated via thoracosopy previously.…”

Section: Discussionmentioning

confidence: 91%

“…Approximately, 70-75% of symptoms disappear in early period following surgery. (22)(23) Bertolini et al (23) evaluated that the remaining symptoms, which are approximately %30, tend to disappear at a later period. We also had no residual symptoms except for one case suffering from asthma.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Surgical Correction at Vascular Ring Anomalies

Bilen¹,

Akkaya²,

Ayık³

et al. 2018

ejcm

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In this retrospective study, we present our fifteen years of experience in surgical treatment in vascular rings. Thus, we aimed to determine the factors that causing improved both early and late term complications. Methods: Sixteen patients who underwent surgical treatment with the diagnosis of vascular ring between 2003-2018 were included in this study. Hospital records were analyzed retrospectively. Demographic data of the patients, preoperative symptoms and postoperative outcomes were evaluated. Results: The patients were mean 43.50±38.61 months of age and weighed 26.00±13.81 kg at the time of surgeries. 6 patients (37.5%) were diagnosed with double aortic arch, 7 patients (43.7%) had left arcus aorta associated with right aberrant subclavian artery and 3 patients (18.7%) had right arcus aorta and left ligamentum arteriosum. The most common symptom was cough followed by shortness of breath, difficulty in swallowing, reflux, recurrent pneumonia respectively. One patient had atrial septal defect, another patient had ductus arteriosus and another patient had ventricular septal defect as a coexisting cardiac disorder. As early complications, we observed cylothorax, pneumothorax and need of tracheostomy due to failure of extubation in three cases. Mean follow up time was 7.00±3.57 years. Patients had no complaints except for one case with asthma. However, there was no pressure measured on trachea in that patient. No patients died during hospitalizations or follow-ups. Conclusion: Vascular rings can manifest with various symptoms at different ages and many patients also have co-existing cardiac anomalies. However, once the diagnosis is confirmed, surgical approach is essential and leads to satisfactory, uneventful long-term survival results.

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“…The association between thoracoscopy and shorter hospitalisation has been observed in prior studies 6,8 as well as other lesions, including vascular rings. 13 However, there is some disagreement in the literature, as other groups have reported no difference, although these either had fewer patient numbers or had focused on neonates and infants rather than patients receiving elective surgery. 5,7 In contrast, there does appear to be general agreement regarding an association between thoracoscopy and reduced ICU stay.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Outcomes following thoracotomy or thoracoscopic vascular ring division in children and young adults

Abstract: Vascular ring division by either thoracotomy or VATS can be performed with low rates of complication and need for reintervention. Compared with thoracotomy, VATS is associated with shorter operative duration and hospital LOS among patients with RAA with LSCA/LL.

Cited by 33 publications

References 19 publications

Borrowing from Adult Cardiac Surgeons—Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era

Borrowing from Adult Cardiac Surgeons—Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era

Assessment of Surgical Correction at Vascular Ring Anomalies

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

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