No abstract

Surprisingly few (26.3%) studies mention what pulmonary annulus size "cutoff" was used to decide when to insert a TAP. Z-scores derived from different populations were used by different studies and it is possible that this may have contributed to the varied "cutoffs' quoted. Recommendations to perform valve-sparing surgery in pulmonary annuli as small as -4 may not be warranted. Future papers should record "cutoffs" employing recommended z-score data set.

The use of varied tricuspid valve annuli z-score data sets may have contributed to gross variations in reported "cutoffs" for successful biventricular repair. This could lead to inappropriate surgical pathway allocation.

BackgroundThere is clinical equipoise regarding post-operative management of patients with patent ductus arteriosus (PDA) without insertion of a chest drain. This study evaluated post operative outcomes of chest closure with or without a drain following Patent Ductus Arteriosus ligation among childen at Uganda Heart Instritute (UHI).MethodsThis was an open label randomized controlled trial of 62 children 12 years of age and below diagnosed with patent ductus arteriosus at Mulago National Teaching and Referral Hospital, Uganda. Participants were randomized in the ratio of 1:1 with surgical ligation of patent ductus arteriosus to either thoracotomy closure with a chest tube or without a chest tube. All participants received standard care and were monitored hourly for 24 hours then until hospital discharge. The combined primary endpoint consisted of significant pleural space accumulation of fluid or air, higher oxygen need or infection of the surgical site. Analysis was conducted by multivariable logistic regression analysis at 5 % significance level.ResultsWe enrolled 62 participants, 46 (74 %) of whom were females. Their median age was 12 months (IQR: 8–36). Participants in the no-drain arm significantly had less post-operative complications compared to the drain arm (Unadjusted odds ratio [uOR]: 0.21, 95 % CI: 0.06–0.73, p = 0.015). This “protective effect” remained without statistical significance in the multivariable regression model (Adjusted odds ratio [aOR]: 0.07, 95 % CI: 0.00–2.50, p = 0.144).ConclusionChildren aged below 6 years with patent ductus arterious can safely and effectively have thoracotomy closure without using a drain in uncomplicated surgical ligation of the PDA. Chest drain was associated with post-operative complications.Trial registrationThe trial was registered in the Pan African Clinical Trials registry on 1st/July/2012, retrospectively registered. Identifier number PACTR201207000395469.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-016-0182-x) contains supplementary material, which is available to authorized users.