Sana Heart Center Cottbus, Cottbus, Germany, Germany; Heart Diseases Center MEDINET, Nowa Sol, Poland, Poland.
Kardiol Pol. 2018;76(4):750-754. doi: 10.5603/KP.2018.0009. Epub 2018 Jan 9.
Patent ductus arteriosus (PDA) occurs more frequently in premature infants. Depending on the degree of prematurity, these children often have other serious comorbidities that could have a significant impact on surgical outcome.
This study aimed to evaluate the clinical results of surgical ligation of PDA in extremely low body weight preterm infants with birth weight below 750 g, and to identify risk factors of mortality.
A total of 31 preterm infants with birth weight below 750 g and significant PDA were operated between 2006 and 2016 through posterolateral thoracotomy (n = 16) or with the use of video-assisted thoracoscopic method (n = 15). Mean weight at the time of surgery was 750.8 ± 104.7 g. The gestational age ranged from 22 to 32 weeks. Data were retrospectively analysed, and prospective 100% follow-up was performed.
In-hospital mortality was 25.8% (n = 8). The type of surgery had no influence on the results. During the follow-up period lasting 5.2 ± 2.5 years, two other patients died. One-year and five-year probability of survival was 77.4% and 74.2%, respectively. The predominant cause of death was acute heart failure. All patients with preoperative renal dysfunction died in the postoperative period. Moreover, Cox regression analysis revealed renal dysfunction as an independent risk factor of early death.
Preterm infants with birth weight less than 750 g and significant PDA are highly challenging patients. Despite the recent advances in perioperative management with neonates, surgery is still associated with a high early mortality rate irrespective of the applied method.
动脉导管未闭（PDA）在早产儿中更为常见。根据早产程度的不同，这些儿童通常还伴有其他严重的合并症，这可能对手术结果产生重大影响。
本研究旨在评估出生体重低于 750g 的极低体重早产儿中 PDA 手术结扎的临床结果，并确定死亡率的危险因素。
2006 年至 2016 年期间，通过后外侧开胸术（n=16）或使用电视辅助胸腔镜方法（n=15）对 31 名出生体重低于 750g 且存在明显 PDA 的早产儿进行了手术。手术时的平均体重为 750.8±104.7g。胎龄范围为 22 至 32 周。对数据进行回顾性分析，并进行了前瞻性 100%随访。
院内死亡率为 25.8%（n=8）。手术类型对结果没有影响。在随访 5.2±2.5 年期间，另外 2 名患者死亡。1 年和 5 年生存率分别为 77.4%和 74.2%。死亡的主要原因是急性心力衰竭。所有术前肾功能不全的患者均在术后死亡。此外，Cox 回归分析显示肾功能不全是早期死亡的独立危险因素。
出生体重低于 750g 且存在明显 PDA 的早产儿是极具挑战性的患者。尽管最近在新生儿围手术期管理方面取得了进展，但无论采用何种方法，手术仍与高早期死亡率相关。
