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International Society For Minimally Invasive Cardiothoracic Surgery

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Video-assited Thoracoscopic Surgery Versus Open Thoracotomy For Vascular Ring Anomaly In Pediatric Patients
Corazon Mabel Calle Valda, Enrique Garcia Torres, Lorenzo Boni, Javier Arias Dachary, Manuel Melo, Indalecio Cano Novillo, Araceli Garcia Vazquez.
Hospital Universitario 12 de Octubre, Madrid, Spain.

BACKGROUND: The use of video-assisted thoracoscopic surgery (VATS) is becoming increasingly common in the treatment of congenital heart defects, particularly for the division of vascular rings (Figure 1). We compare the short-term outcomes of vascular ring division by VATS and compared this approach with conventional open thoracotomy. METHODS: This study is a retrospective review of patients with syntomatics vascular rings, who underwent division via left thoracotomy or VATS approach at a single institution between November 1999 and October 2019. We present our technique for performing VATS. We reviewed preoperative, operative, and postoperative data. Comparisons were made between operations performed by open thoracotomy and by VATS. RESULTS: A total of 17 patients underwent vascular ring division by VATS (n =5) or thoracotomy (n = 12) were analized. Median age was 5.7 years (range: 1.7-9.7 years) in the thoracoscopic group and 2.3 years (range: 1 month- 14 years) in the open group (p=0.61). Median weight was 18.1 Kg (range: 9-26.8 Kg) in the thoracoscopic group and 11.4 Kg (range: 3- 54 Kg) in the open group (p=0.83). The thoracoscopic group did not differ in preoperative symptoms with the open group (Table 1). The operative time was shorter in the thoracoscopic group (65.411.9 vs 180.5 51.2; p=0.05) and all patients were extubated in the operating room. The complications in the open group were chylothorax (n=3), pulmonary complications (n=2), dysphonia (n=1), esophageal perforation (n=1) and recurrent urinary tract infection (n=1). In the thoracoscopic group, only one case of mild left subcutaneous emphysema was observed. There was no significant difference in the intensive care unit stay (1.20.4 vs 1.5 0.8; p=0.13) however, the total length of stay was shorter in the thoracoscopic group (3.40.5 vs 13.817.9; p=0.04). At follow-up visit within one month after surgery, most patients (100% vs 92%) reported improvement in symptoms. CONCLUSIONS: Video-assisted thoracoscopic division of vascular rings in pediatric patients is a feasible alternative to division by thoracotomy and is associated with shorter operative duration and decreased length of hospital stay and chylothorax.

Table 1. Clinical characteristics of 17 patients undergoing vascular ring division 1999-2019
Diagnosis n(%)Thoracotomy groupThoracoscopic group
Right Aortic Arch with left subclavian artery/Left ligamentum2 (16.7%)5 (100%)
Double Aortic Arch with patent arch8 (66.7%)0 (0%)
Double Aortic Arch with atretic arch2 (16.7%)0 (0%)
Symptoms at presentation, n (%)
Respiratory11 (91.7%)2 (40%)
Gastroesophageal0 (0%)3 (60%)
Both1(8.3%)0 (0%)

LEGEND: Figure 1. Video-assisted thoracoscopic surgery in patients with vascular ring.

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