eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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2/2018
vol. 15
 
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abstract:
Original paper

Conversion to thoracotomy of video-assisted thoracoscopic closure of patent ductus arteriosus

Tomasz Stankowski
,
Sleiman Sebastian Aboul-Hassan
,
Dirk Fritzsche
,
Marcin Misterski
,
Jakub Marczak
,
Anna Szymańska
,
Katarzyna Wijatkowska
,
Cyprian Augustyn
,
Romuald Cichoń
,
Bartłomiej Perek

Kardiochirurgia i Torakochirurgia Polska 2018; 15 (2): 102-106
DOI: https://doi.org/10.5114/kitp.2018.76475
Online publish date: 2018/06/22
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Introduction
Posterolateral thoracotomy was the access of choice in surgical treatment of patent ductus arteriosus (PDA) for many years before the introduction of video-assisted thoracoscopic surgery (VATS). The latter is thought to reduce postoperative pain and improve musculoskeletal system status. However, it carries a potential risk of conversion to thoracotomy.

Aim
To evaluate the rate, reasons and outcomes of VATS conversion to thoracotomy in surgical PDA patients.

Material and methods
From 2012 to 2017, 112 children were qualified for VATS closure of symptomatic PDA. Among them, 19 (16.9%) with the median age of 19.4 months required conversion to thoracotomy. The predominant reasons for conversion, early mortality and morbidity as well as late survival were evaluated.

Results
The overall conversion rate was 16.9% with an evident learning curve as it decreased significantly from more than 20% at the beginning to approximately 10% in the last 2 years. The predominant reasons were incomplete PDA closure (n = 6; 31.6%) followed by ductal bleeding after clip application (n = 5; 26.3%) and inadequate visualization (n = 5). One child died 48 h after the surgery due to acute cardiopulmonary failure (mortality 5.9%). All patients required postoperative chest tube insertion, and two of them developed postoperative pneumothorax. Neither deaths nor severe adverse events were noted throughout the follow-up period.

Conclusions
The rate of VATS PDA closure conversion to standard thoracotomy features a learning curve. Although it must be considered as a serious complication, probably it does not negatively affect either early the mortality rate or long-term survival.

keywords:

patent ductus arteriosus, video-assisted thoracoscopic surgery, conversion, outcomes
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