Bedside surgical ligation of the patent ductus arteriosus in very‐low‐birth‐weight premature infants: Limited upper ministernotomy as an alternative approach

Abstract

Background: Patent ductus arteriosus (PDA) is an important cause of morbidity and mortality, especially in very-low-birth-weight infants. The aim of the present study was to evaluate the outcomes of bedside surgical ligation of PDA via limited upper ministernotomy as an alternative approach to thoracotomy. Materials and Methods: A total of 23 low-birth-weight premature infants, who underwent bedside ligation of PDA in the neonatal intensive care unit between January 2017 and April 2020, were enrolled. The patients were divided into two groups: those with thoracotomy (n = 13) and those with limited upper ministernotomy (n = 10). These patients were evaluated retrospectively in terms of clinical and preoperative, intraoperative, postoperative parameters between the groups. Results: Mean birth weight was 1059 ± 275 g in the thoracotomy group and 1035 ± 285 g in the ministernotomy group. There was no statistically significant difference in the age at surgery, weight at surgery, preoperative mechanical ventilation (MV) support, inotropic score onset of surgery, and total procedure time between the groups. There was a statistically significant difference in the hospital length of stay, postoperative MV time, and complications in the intensive care unit in favor of the ministernotomy group (p = .04, p = .03, p = .034, respectively). The study showed no statistically significant difference in the mortality rate between the two groups (two patients in the thoracotomy group and one patient in the ministernotomy group). Conclusion: The limited upper ministernotomy is an anatomically and technically feasible alternative to classical left posterolateral thoracotomy for bedside surgical PDA ligation.

An Update on Patent Ductus Arteriosus and What is Coming Next

“…Many albeit small observational retrospective studies on bedside PDA surgery in ventilator-dependent preterm infants (range: 23-32 GA weeks; mean postnatal age 16-32 days on the day of surgery) have reported that there are no additional surgically associated complications. [120][121][122][123] The surgical approach applied is usually the posterolateral thoracotomy, but in a small retrospective study mini-sternotomy appeared to be associated with shorter postoperative mechanical ventilation and length of stay. 123 In a recent large multicenter retrospective study comparing PDA ligations in the operating room (OR) and the NICU, no differences in mortality or sepsis could be detected after correcting for differences in GA, besides an increased postoperative hemodynamic instability in the OR group.…”

“…[120][121][122][123] The surgical approach applied is usually the posterolateral thoracotomy, but in a small retrospective study mini-sternotomy appeared to be associated with shorter postoperative mechanical ventilation and length of stay. 123 In a recent large multicenter retrospective study comparing PDA ligations in the operating room (OR) and the NICU, no differences in mortality or sepsis could be detected after correcting for differences in GA, besides an increased postoperative hemodynamic instability in the OR group. 124 Similar findings with no differences in mortality or complications after PDA ligation performed either in the OR or the NICU were presented in a 2-center retrospective cohort study from 2021, with a significantly earlier closure in the NICU group by 24 days.…”

“…In the preterm lung, there is a delicate balance between increased fluid infiltration induced by PDA and lung lymphatic fluid reabsorption. Any increase in pulmonary microvascular pressure can cause a sudden increase in interstitial and Turk Arch Pediatr 2022; 57(2): [118][119][120][121][122][123][124][125][126][127][128][129][130][131] Erdeve et al alveolar lung fluid because the premature newborn has low oncotic pressure and high capillary permeability. 72 This inadequate structural development and function of the pulmonary vessels is an important feature of BPD.…”