VIDEO-ASSISTED THORACOSCOPIC LIGATION OF PATENT DUCTUS-ARTERIOSUS - SAFE AND OUTPATIENT

Background. Minimally invasive techniques for interruption of patent d uctus arteriosus have been reported, but are in use at only a few cent ers. We examined our series of patients who underwent thoracoscopic pa tent ductus arteriosus ligation. Methods. We reviewed 59 consecutive p atients, age 6 days to 50 years, weighing 640 g to 62 kg, who underwen t video-assisted placement of a stainless steel clip across the patent ductus arteriosus. Results. Thirty-eight nonneonates and 21 neonates (18 were less than or equal to 1,500 g) underwent video-assisted thora cic surgery for patent ductus arteriosus closure with intraoperative e chocardiographic confirmation in nonneonates. There were no residual s hunts, transfusions, chylothoraces, or significant pneumothoraces. Fou r were converted to thoracotomy, 3 for anatomic variances, and 1 for c oagulopathy. Thirty-six of 38 nonneonate patients stayed less than 24 hours; 18 were discharged the evening of the operation. Two were admit ted, one after thoracotomy, and one for a small mucosal intubation inj ury. No others required a chest tube. There were two recurrent nerve i njuries. All neonates survived, and were extubated. Conclusions. Video -assisted thoracoscopic ductus closure is a safe, reliable technique a nd can be performed as an outpatient procedure in nonneonate patients. (Ann Thorac Surg 1998;66:853-9) (C) 1998 by The Society of Thoracic S urgeons.