Stankowski Tomasz, Aboul-Hassan Sleiman Sebastian, Seifi-Zinab Farzaneh, Fritzsche Dirk, Misterski Marcin, Sazdovski Ivan, Marczak Jakub, Szymańska Anna, Szarpak Lukasz, Ruetzler Kurt, Ahuja Sanchit, Perek Bartłomiej
Sana Heart Center Cottbus, Cottbus, Germany.
Heart Diseases Center MEDINET, Nowa Sol, Poland.
J Thorac Dis. 2019 Jun;11(6):2555-2563. doi: 10.21037/jtd.2019.05.59.
Less invasive procedures such as video-assisted thoracoscopic surgery (VATS) are desirable for patent ductal artery (PDA) ligation when pharmacologic or conservative approaches fail. Studies done on VATS-PDA ligation showed better outcomes when compared to open thoracotomies, however, complication rates remain conflicting. Learning curve can be a postulated reason which may also precludes the acceptability. We therefore sought to report our single centered 7-year experience of PDA closure with VATS.
Single centered retrospective study of 127 patients who underwent PDA ligature with VATS from February 2012 to October 2018. The cohort was divided into two groups, i.e., 2012-2014 (early phase) and 2015-2018 (late phase) and were further compared. Early and late outcomes, including mortality and morbidity, were analyzed.
The included patients had a mean age of 1.7 years. Among them, preterm infants accounted for 38.6%, there was no operative mortality. Six deaths (4.7%) occurred during in-hospital stay, predominantly in the neonatal intensive care unit (NICU) due to massive cerebral bleeding and cardiopulmonary failure. Overall conversion rate to thoracotomy was 16.5%. It decreased from 20% in early phase to less than 5% in late phase. Fifty patients (39.4%) required transfer to the NICU. The mean in-hospital stay for the remainders was only 2.2±1.6 days. All but two patients discharged home survived follow-up period without any adverse events and nobody among non-converted cases expressed concerns regarding chest deformity. A 5-year probability of survival estimated according to the Kaplan-Meier curve was 93.6%.
VATS is a safe as well as efficient method for closure of PDA that ensures satisfactory late cosmetic results. Postoperative mortality and extended hospital stay may be attributed to prematurity. Although learning curve exists it does not affect the safety and late outcomes.
当药物治疗或保守治疗方法失败时，诸如电视辅助胸腔镜手术（VATS）等侵入性较小的手术对于动脉导管未闭（PDA）结扎术而言是可取的。对VATS-PDA结扎术的研究表明，与开胸手术相比，其结果更好，然而，并发症发生率仍存在争议。学习曲线可能是一个假定的原因，这也可能妨碍其可接受性。因此，我们试图报告我们单中心7年的VATS闭合PDA的经验。
对2012年2月至2018年10月期间接受VATS PDA结扎术的127例患者进行单中心回顾性研究。该队列分为两组，即2012 - 2014年（早期）和2015 - 2018年（晚期），并进行进一步比较。分析早期和晚期结果，包括死亡率和发病率。
纳入患者的平均年龄为1.7岁。其中，早产儿占38.6%，无手术死亡。6例死亡（4.7%）发生在住院期间，主要在新生儿重症监护病房（NICU），原因是大量脑出血和心肺衰竭。总体开胸转换率为16.5%。从早期的20%降至晚期的不到5%。50例患者（39.4%）需要转入NICU。其余患者的平均住院时间仅为2.2±1.6天。除两名患者外，所有出院患者在随访期内存活且无任何不良事件，未转换病例中无人对胸部畸形表示担忧。根据Kaplan-Meier曲线估计的5年生存率为93.6%。
VATS是一种安全且有效的PDA闭合方法，可确保令人满意的后期美容效果。术后死亡率和延长的住院时间可能归因于早产。虽然存在学习曲线，但它并不影响安全性和后期结果。
