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Published on: December 23, 2022
Is thoracoscopic patent ductus arteriosus closure superior to conventional surgery?
Tomasz Stankowski1, Sleiman Sebastian Aboul-Hassan1, Jakub Marczak2
1Department of Cardiac Surgery, MEDINET Heart Center Ltd, Wroclaw, Poland.
Insights
Video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus (PDA) closure shows comparable mortality to conventional surgery. VATS may offer benefits in reduced operative time, hospital stay, and postoperative complications, particularly in younger patients.
Area of Science:
- Cardiac Surgery
- Thoracic Surgery
- Pediatric Cardiology
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect requiring closure.
- Conventional surgical closure involves thoracotomy, while thoracoscopic approaches offer a minimally invasive alternative.
Purpose of the Study:
- To compare the efficacy and safety of video-assisted thoracoscopic surgery (VATS) versus conventional surgery for PDA closure.
- To evaluate outcomes including mortality, operative time, hospital stay, complications, and cost-effectiveness.
Main Methods:
- A systematic review of 11 studies (2 prospective, 3 retrospective non-randomized, 6 case series) was conducted.
- Studies included patients from neonates to young adults undergoing PDA closure.
- Data on mortality, operative time, hospital stay, complications, and cost were extracted and analyzed.
Main Results:
- No significant difference in mortality was observed between VATS and conventional surgery.
- VATS was associated with shorter operative times and potentially shorter hospital stays in some studies.
- VATS showed a trend towards fewer postoperative complications, particularly in neonates and infants, though evidence was limited for other outcomes like cosmesis.
Conclusions:
- Both VATS and conventional surgery are safe and effective for PDA closure across all age groups.
- VATS may offer advantages in terms of reduced pain, postoperative complications, hospital stay, and cost-effectiveness, supporting its use as a preferred approach where available.
Abstract:
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether thoracoscopic patent ductus arteriosus (PDA) closure is superior to conventional surgery. Altogether 821 papers were found using the reported search, 11 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Eleven studies included in the analysis consisted of two prospective and three retrospective, non-randomized studies and six case series. Four included studies focused only on preterm infants, three studies enrolled neonates and the other four analysed all age groups from neonates to older children or young adults. There were no differences in mortality between video-assisted thoracoscopic surgery (VATS) and conventional surgery. Two studies suggested that VATS offers shorter operative times. Two papers observed shorter hospital stay, although the other two noted no significant difference. A large prospective trial found VATS to be associated with a lower number of postoperative complications in neonates and infants, whereas other studies suggested no significant differences in short-term postoperative complications. There is little evidence to suggest better musculoskeletal status and cosmesis in neonates following VATS. Conversion from thoracoscopy to thoracotomy described in six papers was seldom and it did not lead to any additional complications. All observational studies confirmed that both techniques are free from major adverse cardiovascular complications and these two techniques can be safely used in all patients qualified for surgical PDA closure. Two studies compared cost-effectiveness between the two techniques; one of them described VATS as significantly more cost-efficient, whereas the other study observed no difference. However, it should be noted that data were provided from different countries and time periods. The results presented suggest that there are no significant differences in early clinical outcomes between VATS and thoracotomy in all age groups. However, where differences have been shown, such as pain, postoperative complications, length of hospital and ICU stay and cost, these favour the VATS approach.
