Video-assisted thoracoscopic surgery for patent ductus arteriosus in low birth weight neonates and infants

Background. Video-assisted thoracoscopic surgery (VATS) has been assuming a n expanded role in the management of cardiothoracic disease. As instrumenta tion and experience increase, VATS is being applied to treat smaller patien ts. We report our experience with 34 low birth weight infants undergoing VA TS interruption of patent ductus arteriosus (FDA). Methods. VATS allows PDA interruption without the muscle cutting or rib spr eading of a standard thoracotomy. Four small, 3-mm incisions are made along the line of a potential thoracotomy incision. Ports placed through these i ncisions admit endoscopic instruments, a camera, and a vascular clip applie r. Results. Median age at surgery was 15.5 days (range: 1-44 days). Median wei ght at surgery was 930 g (range: 575-2500 g). Twenty patients weighed <1 kg , and 13 weighed <750 g. All patients had congestive heart failure and had either failed indomethacin therapy or had contraindications to indomethacin . Median surgical time was 60 minutes (range: 31-171 minutes). Echocardiograp hy documented elimination of ductal flow in all patients. Operative mortali ty was zero. Four patients (4/34 = 12%) required conversion to open thoraco tomy: 1 because of difficult exposure, 1 because of pulmonary dysfunction a nd anasarca, 1 because of a large l-cm duet, and 1 because of coagulopathy and poor pulmonary compliance. Two patients died before discharge: 1 patien t (surgical weight: 605 g) died on postoperative day 2 because of intracran ial hemorrhage, and 1 patient (surgical weight: 1725 g) died on postoperati ve day 88 because of multiple system organ failure. Follow-up has demonstrated no PDA murmur in any patient, but echocardiograp hy revealed trace ductal flow in 2 patients. Conclusions. VATS offers a minimally traumatic, safe, and effective techniq ue for PDA interruption in low birth weight neonates and infants.