Video-assisted Thoracoscopic Interruption For Patent Ductus Arteriosus In Extremely Low Birth Weight Neonates
KAGAMI MIYAJI, Kohichi Sughimoto, Norihiko Oka, Mamika Motokawa, Tadashi Kitamura, Kensuke Kobayashi.
Kitasato University Hospital, Sagamihara, Japan.
OBJECTIVE: The hospital mortality of patent ductus arteriosus closure is not low in extremely low birth weight premature neonates (less than 1 kg), because of prematurity, including enterocolitis, sepsis, heart failure, and late respiratory failure. We have applied video-assisted thoracic interruption of PDA (VATSPDA) in these patients group, to improve the surgical results, and now report our experience.
METHODS: We reviewed consecutive 63 extremely low birth weight neonates undergone VATSPDA. The VATSPDA was performed without a standard thoracotomy. Two small incisions (4 and 8 mm) are made along the line of a potential thoracotomy incision. Ports placed through these incisions admit endoscopic instruments, a camera (2.7 mm in diameter), and a vascular clip applier. Mean gestation age was 26 weeks (range: 24-36 weeks), and mean age at surgery was 26 days (range: 13 - 59 days). Mean body weight at surgery was 770 ± 147g (range: 420 - 990 g). All patients were intubated and managed by mechanical ventilation because of congestive heart failure and respiratory failure. The mean administration time of indomethacin was 4.1 times (range: 0 - 6).
RESULTS: Mean procedure time was 30 ± 11 minutes (range: 15-55 minutes). Mean size of PDA was 3.2 ± 0.6 mm (range: 2 - 4.5). Echocardiography documented elimination of ductal flow in all patients. One patients (1.6%) (surgical weight: 460 g) required conversion to open thoracotomy, because of coagulopathy and poor pulmonary compliance. This patient and the smallest patients (surgical weight: 420 g) (3.2%) died, because of bronchial bleeding. There was one hospital death due to renal failure. Sixty patients (95.2%) discharged home without any complications. The mean follow up periods was 70 months. Follow-up has demonstrated no residual shunts and no late deaths. The multiple regression analyses (Cox regression Hazard model) revealed that the body weight at surgery is only potential risk factor for motality (Hazard ratio: 0.976, 95%CI: 0.956-0.997, P=0.025).
CONCLUSIONS: VATS technique is safe and less invasive, and provides excellent surgical results for PDA interruption in extremely low birth weight neonates, less than 1 kg.
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