46 YEARS OF PATENT DUCTUS-ARTERIOSUS DIVISION AT CHILDRENS-MEMORIAL-HOSPITAL-OF-CHICAGO - STANDARDS FOR COMPARISON

Objective The authors reviewed a large surgical experience (during liv e decades) with ligation and division of patent ductus arteriosus (PDA ) in light of previously reported historical standards and present-day alternatives. Summary Background Data Ligation of PDA was first perfo rmed by Gross in 1938. Various surgical techniques used since then hav e included ligation and division, simple ligation, and hemaclip applic ation. Recently introduced therapies include percutaneous transcathete r ductal closure devices (PTDC) and video-assisted thoracotomy (VAT). Percutaneous transcatheter ductal closure device protagonists cite sur gical recurrence rates as high as 22% to justify continued application . Methods Between 1947 and 1993, 98.2% of 1108 patients (premature bab ies excluded) had interruption of PDA by ligation and division. Recent improvements have included muscle-sparing thoracotomy, minimal use of tube thoracostomy, and same-day surgery. Results Mortality was zero a nd morbidity (4.4%) has been low over time. Mean age at surgery has de creased from 5.9 +/- 3.3 years to 3.6 +/- 3.8 years (p < 0.001); patie nts requiring blood transfusion decreased from 34% to 4.6% (p < 0.001) ; and length of hospital stay (LOS) has decreased from 12.1 +/- 2.9 da ys to 3.8 +/- 2.1 days (p < 0.001). Length of stay for the last 27 pat ients was 2.8 +/- 8 days. Patent ductus arteriosus recurrence rate is zero with this technique. Conclusions Recurrence rates for PTDC are hi gh with as yet unknown consequences of large catheter vascular access, endocarditis, or left pulmonary artery stenosis. Video-assisted thora cotomy for PDA interruption has the potential for uncontrolled exsangu inating hemorrhage. Open thoracotomy for PDA ligation and division can be performed safely and without recurrence through a muscle-sparing i ncision with short LOS. All other therapeutic interventions must be co mpared to these standards.