Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

Objective: The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as “rescue” therapy. The objective of this study was to review our institutions’ outcomes of surgical PDA ligation. Methods: All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed. Records were queried to identify surgical complications, perioperative morbidity, and mortality. Outcomes included pre- and postoperative ventilator requirements, pre- and postoperative inotropic support, acute kidney injury, surgical complications, and 30-day mortality. Results: One hundred sixty-six preterm neonates underwent surgical ligation. One hundred twenty-one (70.3%) had failed indomethacin closure. One hundred sixty-four (98.8%) patients required mechanical ventilation prior to surgery. At 17 postoperative days, freedom from the ventilator reached 50%. Of 109 (66.4%) patients requiring prolonged preoperative inotropic support, 59 (54.1%) were liberated from inotropes by postoperative day 1. Surgical morbidity was encountered in four neonates (2.4%): two (1.2%) patients had a postoperative pneumothorax requiring tube thoracostomy, one (0.6%) patient had a recurrent laryngeal nerve injury, and one (0.6%) patient had significant intraoperative bleeding. The 30-day all-cause mortality was 1.8% (n = 3); no deaths occurred intraoperatively. Conclusion: In this retrospective investigation, surgical PDA closure was associated with low 30-day mortality and minimal morbidity and resulted in rapid discontinuation of inotropic support and weaning from mechanical ventilation. Given the safety of this intervention, surgical PDA ligation merits consideration in the management strategy of the preterm neonate with a PDA.

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Primary Surgical Closure Should Be Considered in Premature Neonates with Large Patent Ductus Arteriosus

The Korean Journal of Thoracic and Cardiovascular Surgery ◽

10.5090/kjtcs.2013.46.3.178 ◽

2013 ◽

Vol 46 (3) ◽

pp. 178-184 ◽

Cited By ~ 2

Author(s):

Seong-Min Ko ◽

Young Chul Yoon ◽

Kwang-Hyun Cho ◽

Yang-Haeng Lee ◽

Il-Yong Han ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Premature Neonates ◽

Surgical Closure ◽

Patent Ductus

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Ligation of left pulmonary artery instead of patent ductus arteriosus

Cardiology in the Young ◽

10.1017/s1047951120002784 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1943-1945

Author(s):

Semih Murat Yucel ◽

Irfan Oguz Sahin

Keyword(s):

Surgical Treatment ◽

Pulmonary Artery ◽

Patent Ductus Arteriosus ◽

Surgical Complication ◽

Ductus Arteriosus ◽

Left Pulmonary Artery ◽

Artery Ligation ◽

Surgical Closure ◽

Post Operative Period ◽

Patent Ductus

AbstractDuctus arteriosus is an essential component of fetal circulation. Due to occurring changes in the cardiopulmonary system physiology after birth, ductus arteriosus closes. Patent ductus arteriosus can be closed by medical or invasive (percutaneous or surgical) treatment methods. Percutaneous or surgical closure of patent ductus arteriosus can be performed for the cases that medical closure failed. Surgical treatment is often preferred method for closure of patent ductus arteriosus in the neonatal period. The most common surgical complications are pneumothorax, recurrent laryngeal nerve injury, bleeding, and recanalisation. A very rare surgical complication is left pulmonary artery ligation that has been presented in a few cases in the literature. Echocardiography control should be performed in the early post-operative period, especially in patients with clinical suspicion. If reoperation is required, it should never be delayed. We report a newborn patient whose left pulmonary artery ligated accidentally during patent ductus arteriosus closure surgery and surgical correction of this complication at the early post-operative period.

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SURGICAL CLOSURE OF ATYPICAL PATENT DUCTUS ARTERIOSUS

Journal of Thoracic Surgery ◽

10.1016/s0096-5588(20)30930-2 ◽

1956 ◽

Vol 31 (3) ◽

pp. 332-337

Author(s):

N.A. Antonius ◽

L.G. Massarelli ◽

A.D. Crecca

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Surgical Closure ◽

Patent Ductus

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Cardiac Output in Premature Neonates with Respiratory Distress Syndrome and Patent Ductus Arteriosus

Pediatric Research ◽

10.1203/00006450-199904020-00164 ◽

1999 ◽

Vol 45 (4, Part 2 of 2) ◽

pp. 27A-27A

Author(s):

Andrzej Malecki ◽

Jan Mazela ◽

Janusz Gadzinowski ◽

Dharmapuri Vidyasagar

Keyword(s):

Cardiac Output ◽

Patent Ductus Arteriosus ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Ductus Arteriosus ◽

Premature Neonates ◽

Patent Ductus

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Ligation of Patent Ductus Arteriosus in Premature Neonates

Southern Medical Journal ◽

10.1097/00007611-198101000-00009 ◽

1981 ◽

Vol 74 (1) ◽

pp. 21-23 ◽

Cited By ~ 1

Author(s):

BRENDAN T. FINUCANE ◽

PETER N. SYMBAS ◽

REBECCA BRASWELL ◽

Atlanta Ga

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Premature Neonates ◽

Patent Ductus

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Low-Dose Intravenous Paracetamol for Patent Ductus Arteriosus in Indomethacin-Resistant or Contraindicated Preterm Infants: Three Cases Reports

American Journal of Perinatology Reports ◽

10.1055/s-0037-1615260 ◽

2017 ◽

Vol 07 (04) ◽

pp. e230-e233 ◽

Cited By ~ 1

Author(s):

Shun Matsumura ◽

Ayumi Oshima ◽

Sumie Fujinuma ◽

Kosuke Tanaka ◽

Nobuhiko Nagano ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Premature Infants ◽

Ductus Arteriosus ◽

Limited Data ◽

Gastrointestinal Complications ◽

Surgical Closure ◽

Institutional Ethics ◽

Intravenous Paracetamol ◽

Administration Protocol ◽

Patent Ductus

Background Although indomethacin (IND) is the standard treatment for hemodynamically significant patent ductus arteriosus (hsPDA) in Japan, it may be associated with renal impairment and gastrointestinal complications. The use of paracetamol for hsPDA closure has recently increased. Unlike IND, paracetamol does not have a peripheral vasoconstrictive effect and can be given to infants with contraindications to IND. Based on limited data available from randomized trials, paracetamol and IND seem to have similar effects. However, there have been no reports of the use of paracetamol for hsPDA in Japan. Cases Our drug administration protocol was approved by the institutional ethics committee after purchasing a clinical trial insurance. In three premature infants in whom IND was contraindicated or ineffective, a 7.5 mg/kg of paracetamol was intravenously administered every 6 hour for 3 days after obtaining parental consents. A temporary hsPDA closure was observed in two of the three infants. However, all three infants eventually needed surgical closure. No side effects, such as hepatic and renal dysfunctions, and adverse events were reported. Conclusion The intravenous administration of paracetamol was safe and feasible in premature infants with hsPDA. Future clinical trials with optimized dose and timing of administration are needed.

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