COMPARISON OF MUSCLE-SPARING THORACOTOMY AND THORACOSCOPIC LIGATION FOR THE TREATMENT OF PATENT DUCTUS-ARTERIOSUS

Purpose: We reviewed our experience with the treatment of patent ductu s arteriosus (PDA), and compared two therapeutic techniques; muscle-sp aring thoracotomy (MST) and thoracoscopic PDA ligation (TPDAL). Method s: We reviewed the clinical records and operative reports of 19 nonnew born patients who were treated at our institution for PDA. Eleven pati ents underwent TPDAL and eight patients MST. The TPDAL patients underw ent thoracoscopic clipping (ligation) of the PDA, whereas the MST grou p had a complete division of the ductus. A two-tailed Student's t test was used to calculate the 95% confidence intervals for length of oper ation, number of doses of intravenous narcotics and hospital stay. Cos ts were also compared. Results: All patients underwent diagnostic echo cardiography in the evaluation of an asymptomatic murmur. Both groups were similar in age (average, 4 years) and gender. All procedures were performed electively. Two thoracoscopic attempts were aborted, one fo r bleeding and the other for inadequate clip size. The length of the p rocedure averaged 1.3 hours +/- 0.330 SD for TPDAL versus 1.4 hours +/ - 0.335 SD for MST Five of the nine successful TPDAL patients were adm itted to the Pediatric Intensive Care Unit (PICU) with an average leng th of stay of 20 hours, and two of eight MST patients stayed in the PI CU for average of 18 hours. All patients were extubated after the proc edure. Chest tubes were placed in two TPDAL patients and three MST pat ients. However, two patients who underwent TPDAL required tube thoraco stomy for persistent postoperative pneumothorax. Average number of int ravenous narcotics administered for the TPDAL was 1.2 doses per patien t and for MST, 1.75 doses per patient. Mean hospital stay for TPDAL wa s 1.33 +/- 0.71 SD days and for MST 1.8 +/- 0.83 SD days. Ninety-five percent (95%) confidence intervals for the difference in means demonst rated no difference between the two groups for length of operation, ho spital slay, or number of doses of intravenous narcotics administered. Conclusions: The authors were unable to identify any benefit to thora coscopic patent ductus arteriosus ligation versus muscle-sparing thora cotomy in terms of hospital stay, length of operation, or morbidity. A dditionally, with MST there is a complete division of the PDA theoreti cally decreasing the risk of recurrence in comparison with clip ligati on. Copyright (C) 1998 by W.B. Saunders Company.