Video-assisted thoracoscopic clipping of patent ductus arteriosus: close to the gold standard and minimally invasive competitor of percutaneous techniques.
OBJECTIVE
To review our 12-year experience in video-assisted thoracoscopic surgery (VATS) for patent ductus arteriosus.


METHODS
VATS was performed in 743 patients. Three groups were compared: 24 low-birth-weight infants (LBWIs), 676 children between 2.5-25 kg and 43 boys > 25 kg. A diameter of > 8 mm was the main contraindication. For 85 consecutive patients, hospital stay underwent cost analysis.


RESULTS
Median age was 1.6 years (range 5 days-33 years) and median weight 9.0 kg (range 1.2-65 kg). Mortality was nil. Median operative time was 20 min and hospital stay 2 days. Residual patency at discharge was 0% in LBWIs, 0.7% in children, and 4.7% in boys (P = NS) and 0, 0.3, and 4.7% at follow-up (P = 0.001). Persistent recurrent laryngeal nerve dysfunction was recorded in 4.2% of LBWIs, 0.3% of children and 0% of boys (P = 0.012). Total mean cost was Euro 5954 +/- 2110.


CONCLUSIONS
The success rate of VATS clipping compares favorably with the thoracotomic approach but without chest wall trauma and it may have a very favorable cost-effective therapeutic balance compared to transcatheter techniques.
Villa
Emmanuel
E
Cardiac Pathology Department, Institut Mutualiste Montsouris, Paris, France. emmanuel.villa@voila.fr
Folliguet
Thierry
T
Magnano
Diego
D
Vanden Eynden
Frédéric
F
Le Bret
Emmanuel
E
Laborde
François
F
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000191:economics / Q000601:surgery*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007558:Italy; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics; D013908:Thoracotomy; D014826:Vocal Cord Paralysis / Q000453:epidemiology