Video-assisted ductal closure with new modifications: minimally invasive, maximally effective, 1,300 cases.

Abstract

Video-assisted thoracoscopic surgery (VATS) has been shown to be a safe and effective method of closing patent ductus arteriosus (PDA). We retrospectively studied our series of patients with PDA who underwent VATS closure with new modifications. From June 1997 to December 2004, 1,300 consecutive patients diagnosed with PDA (mean age, 6 years) were referred to us, and all of them met our inclusion criteria for the VATS procedure. Recently, we made some minor alterations to our routine methodology. After complete closure of PDA by two titanium clips, the extubated patient leaves the operating room without a chest tube. There were 3 cases of chylothorax, which were successfully treated by thoracotomy and ligation of the small lymphatic ducts after 1 week of close observation. The procedure was changed to thoracotomy in 7 patients. Meanwhile, 5 additional patients had transient recurrent laryngeal nerve dysfunction. All cases were reassessed immediately after the procedure, and followed for more than 7 years by control echocardiography. No significant complication or residual shunt was recorded during the follow-up period. Mean procedure time was about 10 +/- 2 minutes. All patients were discharged shortly after the procedure (about 20 hours). Based on this experience, VATS appears to be safer and more effective as well as having other advantages such as being simple to perform, quick, and comfortable for the patients. Furthermore, the cosmetic benefits also make it appropriate as an outpatient procedure.