Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-23T22:37:17.881Z Has data issue: false hasContentIssue false
  • English
  • Français

Ligation of patent ductus arteriosus through anterior thoracotomy in preterm infants: a 10-year experience

Part of: Surgery

Published online by Cambridge University Press:  28 January 2021

Arif Selcuk Open the ORCID record for Arif Selcuk [Opens in a new window] ,
Murat Cicek ,
Okan Yurdakok ,
Yigit Kilic ,
Filiz İzgi Coskun ,
Hasan Erdem ,
Turkay Saritas ,
Emine Hekim Yilmaz ,
Oktay Korun  and
H. Firat Altin Open the ORCID record for H. Firat Altin [Opens in a new window]
...Show all authors
Arif Selcuk*
Affiliation:
Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Murat Cicek
Affiliation:
Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Okan Yurdakok
Affiliation:
Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Yigit Kilic
Affiliation:
Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Filiz İzgi Coskun
Affiliation:
Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Hasan Erdem
Affiliation:
Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Center, Istanbul, Turkey
Turkay Saritas
Affiliation:
Department of Pediatric Cardiology, Istanbul Medipol University Medicine Faculty, Istanbul, Turkey
Emine Hekim Yilmaz
Affiliation:
Department of Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Oktay Korun
Affiliation:
Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
H. Firat Altin
Affiliation:
Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Ahmet Sasmazel
Affiliation:
Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
Numan A. Aydemir
Affiliation:
Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
*
Author for correspondence: Dr A. Selcuk, MD, Department of Pediatric Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, 34668, Turkey. Tel: +90-216-542-4444; Fax: +90-216-418-9649. E-mail: kdcaselcuk@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The aim of this study is to report on the short-term and mid-term outcomes of preterm infants who underwent patent ductus arteriosus ligation through anterior mini-thoracotomy.

Methods:

Data for 103 preterm infants who underwent patent ductus arteriosus clipping through an anterior mini-thoracotomy at the 2nd intercostal space between 2009 and 2019 were retrospectively reviewed. The patients were divided into two groups according to their weight at the time of surgery. The complications, morbidity, and mortality rates of each group were compared at postoperative day 30 and at the end of 1 year after surgery.

Results:

During the operation, the median weight of the patients was 900 g (IQR 800–1125 g), the median age was 21 days (IQR 14.5–29 days). The lowest body weight was 460 g. In three patients (3%), there was intraoperative bleeding from the patent ductus arteriosus that required transition to median sternotomy. In one patient (1%) a residual patent ductus arteriosus that required reoperation was observed. Twelve patients (12%) died in the first 30 days postoperatively. Six patients (6%) died between the postoperative day 30 and 1 year. There was no statistically significant difference in the rates of mortality, morbidity, and complication between the groups.

Conclusions:

Based on our observations of over a hundred preterm infants with patent ductus arteriosus over a decade, ligation through anterior mini-thoracotomy is the main surgical procedure of choice for this patient group in our clinic. Our findings demonstrate the safety of this approach and we believe that it can be successfully replicated in other institutions.

Keywords

congenital heart diseaseminimally invasive surgeryinfant
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 6 , June 2021 , pp. 985 - 991
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Sehgal, A, McNamara, PJ. The ductus arteriosus: a refined approach. Semin Perinatol 2012; 36: 105–113.10.1053/j.semperi.2011.09.020CrossRefGoogle ScholarPubMed
Hamrick, SE, Hansmann, G. Patent ductus arteriosus of the preterm infant. Pediatrics 2010; 125: 1020–1030.10.1542/peds.2009-3506CrossRefGoogle ScholarPubMed
Clyman, RI. Ibuprofen and patent ductus arteriosus. N Engl J Med 2000; 343: 728–730.10.1056/NEJM200009073431009CrossRefGoogle ScholarPubMed
Karaci, AR, Sasmazel, A, Turkay, S, et al. Closure of a patent ductus arteriosus in pre-term neonates using a left anterior mini-thoracotomy. J Card Surg 2013; 28: 461–464.10.1111/jocs.12135CrossRefGoogle ScholarPubMed
Coles, JC, Gergely, NF, Buttigliero, J. Banding the pulmonary artery. Clin Pediatr (Phila) 1963; 2: 316–322.10.1177/000992286300200605CrossRefGoogle ScholarPubMed
Fouilloux, V, Gran, C, Kreitmann, B. Surgical closure of persistent arterial duct with minimal invasive anterior thoracotomy: an alternative technique. Eur J Pediatr Surg 2014; 24: 431–432.Google Scholar
Wanert, C, Louali, FE, Ovaert, C, Fouilloux, V. Surgical closure of the patent ductus arteriosus by anterior mini-thoracotomy in very preterm infants. Arch Cardiovasc Dis Suppl, 2019; 11: e396.Google Scholar
Verhaegh, AJFP, Accord, RE, Kooi, EMW, et al. Thoracotomy versus sternotomy for patent ductus arteriosus closure in preterm neonates. Ann Thorac Surg 2020; 109: 171–177.10.1016/j.athoracsur.2019.06.068CrossRefGoogle ScholarPubMed
Bal, S, Elshershari, H, Celiker, R, Celiker, A. Thoracic sequels after thoracotomies in children with congenital cardiac disease. Cardiol Young 2003; 13: 264–267.10.1017/S1047951103000519CrossRefGoogle ScholarPubMed
Raval, MV, Laughon, MM, Bose, CL, Phillips, JD. Patent ductus arteriosus ligation in premature infants: who really benefits, and at what cost? J Pediatr Surg 2007; 42: 69–75.10.1016/j.jpedsurg.2006.09.040CrossRefGoogle ScholarPubMed
Demirturk, O, Guvener, M, Coskun, I, Tunel, HA. Results from extrapleural clipping of a patent ductus arteriosus in seriously ill preterm infants. Pediatr Cardiol 2011; 32: 1164–1167.10.1007/s00246-011-0050-5CrossRefGoogle ScholarPubMed
Garcia, AV, Lukish, J. Minimally invasive patent ductus arteriosus ligation. Clin Perinatol 2017; 44(4): 763–771.10.1016/j.clp.2017.08.010CrossRefGoogle ScholarPubMed
Bansal, NO, Prabhu, S, Ware, D, Shivapuje, SK. Transcathater percutaneous device closure of a large PDA closed in a 3 kg infant. Indian Heart J 2014; 66: 707–709.10.1016/j.ihj.2014.12.002CrossRefGoogle Scholar
Stankowski, T, Aboul-Hassan, SS, Seifi-Zinab, F, et al. Descriptive review of patent ductus arteriosus ligation by video-assisted thoracoscopy in pediatric population: 7-year experience. J Thorac Dis 2019; 11: 2555–2563.10.21037/jtd.2019.05.59CrossRefGoogle ScholarPubMed
Jennings, RB Jr, Innes, BJ, Wirth, FH, Askew, QA. Bedside patent ductus ligation in prematures. Circulation 1975; 52 (Suppl 2): 101.Google Scholar
Stankowski, T, Aboul-Hassan, SS, Fritzsche, D, et al. Surgical closure of patent ductus arteriosus in extremely low birth weight infants weighing less than 750 g. Kardiol Pol 2018; 76: 750–754.10.5603/KP.2018.0009CrossRefGoogle Scholar
Hines, MH, Raines, KH, Payne, RM, et al. Video-assisted ductal ligation in premature infants. Ann Thorac Surg 2003; 76: 1417–1420.10.1016/S0003-4975(03)00682-9CrossRefGoogle ScholarPubMed
Margaryan, R, Arcieri, L, Murzi, B. Surgical closure of PDA in low-weight premature infants. J Matern Fetal Neonatal Med 2009; 22 (Suppl 3): 81–84.10.1080/14767050903195484CrossRefGoogle ScholarPubMed
Kang, SL, Samsudin, S, Kuruvilla, M, Dhelaria, A, Kent, S, Kelsall, WA. Outcome of patent ductus arteriosus ligation in premature infants in the East of England: a prospective cohort study. Cardiol Young 2013; 23: 711–716.10.1017/S1047951112001795CrossRefGoogle Scholar
Iwase, J, Tajtma, K, Io, A, et al. Less invasive surgical closure of patent ductus arteriosus in extremely low birth weight infants. Jpn J Thorac Cardiovasc Surg 2003; 51: 651–655.10.1007/s11748-003-0003-xCrossRefGoogle ScholarPubMed
Avila-Alvarez, A, Serantes Lourido, M, Barriga Bujan, R, Blanco Rodriguez, C, Portela-Torron, F, Bautista-Hernandez, V. Surgical closure of patent ductus arteriosus in prematureneonates: does the surgical technique affect the outcome? An Pediatr (Barc) 2017; 86: 277–283.10.1016/j.anpedi.2015.12.011CrossRefGoogle ScholarPubMed
Lehenbauer, DG, Fraser, CD, Crawford, TC, et al. Surgical closure of patent ductus arteriosus in premature neonates weighing less than 1,000 g: contemporary outcomes. World J Pediatr Congenit Heart Surg 2018; 9: 419–423.10.1177/2150135118766454CrossRefGoogle Scholar