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Published on: December 23, 2022
Minimally invasive thoracoscopic closure versus thoracotomy in children with patent ductus arteriosus
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) ligation in children is safe and effective, offering better cosmetic results and fewer complications than conventional thoracotomy. Long-term survival rates are comparable between both surgical methods.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Congenital Heart Defects
Background:
- Patent ductus arteriosus (PDA) is a common congenital heart defect requiring prompt intervention.
- Surgical closure is a primary treatment option for PDA.
Purpose of the Study:
- To compare the safety and efficacy of video-assisted thoracoscopic surgery (VATS) versus muscle-sparing posterolateral thoracotomy (MSPLT) for PDA ligation in children.
Main Methods:
- A retrospective, single-center study included 173 children undergoing surgical PDA closure.
- Patients were categorized based on surgical approach: thoracotomy (54%) or VATS (46%).
- Evaluated outcomes included operative characteristics, complications, cosmetic results, and long-term survival.
Main Results:
- VATS ligation resulted in fewer postoperative complications compared to thoracotomy.
- Fifteen VATS cases required conversion to thoracotomy without observed adverse effects.
- Aesthetic outcomes were generally superior after VATS, while long-term survival showed no significant difference between groups.
Conclusions:
- Both VATS and MSPLT are safe and effective for pediatric PDA closure.
- VATS offers advantages in terms of reduced complications and improved aesthetics.
- Conversion from VATS to thoracotomy is a safe option when necessary.
Background:
Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Once diagnosed, an immediate pharmacologic or invasive treatment should be performed. The purpose of this work was to evaluate the safety and efficacy of surgical PDA ligation in children using video-assisted thoracoscopic surgery (VATS) in comparison with a conventional muscle-sparing posterolateral thoracotomy technique (MSPLT).
Materials And Methods:
In this single-center, retrospective study 173 children qualified for surgical PDA closure were enrolled. Patients were divided according to their weight and type of surgery performed. The groups consisted of patients operated through thoracotomy (54%) or VATS (46%). Operative characteristics, cosmetic effect, postoperative complications and long-term survival were evaluated.
Results:
Regardless of weight, fewer complications were noted in children after thoracoscopic clipping. Fifteen VATS patients required intraoperative conversion to thoracotomy; however, adverse sequelae were not observed. Aesthetics seemed to be the major complaint after conventional surgery. We did not observe any statistically significant differences in the long-term survival between both groups.
Conclusions:
Both techniques were shown to be safe and effective. Unsuccessfully performed thoracoscopic surgeries were safely converted to conventional thoracotomy. VATS, being a less invasive approach, leads to a better aesthetic effect and lower surgical complication rate.
