Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus

AbstractBackground:Patent ductus arteriosus closure is traditionally performed by thoracotomy approach. Video-assisted thoracoscopic surgery is a less frequently utilised alternative. We sought to compare elective surgical outcomes between the two methods via a single-centre retrospective cohort analysis.Methods:All patients >3.2 kg undergoing surgical patent ductus arteriosus ligation at a single institution from 2000 to 2018 were retrospectively reviewed. Propensity matching for age, weight, diuretic usage, and preterm status was conducted to adjust for differences in baseline patient characteristics. Outcome measures included operative time, hospitalisation duration, post-operative complications, and re-operation.Results:A total of 173 patients were included, 127 thoracoscopy and 46 thoracotomy. In the unmatched cohorts, no significant difference in closure success was found (94% thoracoscopy versus 100% thoracotomy, p = 0.192). Although median operative time was longer for thoracoscopy (87 versus 56 minutes, p < 0.001), hospitalisation duration was shorter (1.05 versus 2.41 days, p < 0.001), as was ICU stay (0.00 versus 0.75 days, p < 0.001). There were no significant differences in re-operation or complication rates, except chest tube placement (11% thoracoscopy versus 50% thoracotomy, p < 0.001). After matching (69 thoracoscopy versus 20 thoracotomy), these differences persisted, including median operative time (81 versus 56 minutes, p = 0.007; thoracoscopy versus thoracotomy), hospitalisation duration (1.25 versus 2.27 days, p < 0.001), and chest tube placement (17% versus 60%, p < 0.001). There remained no significant difference in complications or re-operations.Conclusions:Thoracoscopic ligation was associated with shorter ICU and hospital stays and less frequent chest tube placement, but longer operative times. Other risks, including bleeding, chylothorax, and recurrent laryngeal nerve injury, were similar.

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Efficiency and Safety of Patent Ductus Arteriosus Surgical Ligation in Extremely Low Birth Weight Infants Without Chest Tube Placement

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1731786 ◽

2021 ◽

Author(s):

Georgios Kourelis ◽

Meletios Kanakis ◽

Constantinos Loukas ◽

Felicia Kakava ◽

Konstantinos Kyriakoulis ◽

...

Keyword(s):

Birth Weight ◽

Patent Ductus Arteriosus ◽

Chest Tube ◽

Ductus Arteriosus ◽

Extremely Low Birth Weight ◽

Tube Placement ◽

Chest Tube Placement ◽

Surgical Ligation ◽

Patent Ductus

AbstractPatent ductus arteriosus (PDA) has been associated with increased morbidity and mortality in preterm infants. Surgical ligation (SL) is generally performed in symptomatic infants when medical management is contraindicated or has failed. We retrospectively reviewed our institution's experience in surgical management of PDA for extremely low birth weight (ELBW) infants without chest tube placement assessing its efficiency and safety. We evaluated 17 consecutive ELBW infants undergoing SL for symptomatic PDA (January 2012–January 2018) with subsequent follow-up for 6 months postdischarge. Patients consisted of 9 (53%) females and 8 (47%) males. Mean gestational age (GA) at birth was 27.9 ± 2.1 weeks. Median values for surgical age (SA) from birth to operation was 10 days (interquartile range [IQR]: 8–12); PDA diameter 3.4 mm (IQR: 3.2–3.5); surgical weight (SW) 750 g (IQR: 680–850); and days of mechanical ventilation (DMV) as estimated by Kaplan–Meier curve 22 days (95% confidence interval: 14.2–29.8). We observed a statistically significant negative association between DMV and GA at birth (rho = − 0.587, p = 0.017), SA (rho = − 0.629, p = 0.009) and SW (rho = − 0.737, p = 0.001). One patient experienced left laryngeal nerve palsy confirmed by laryngoscopy. Otherwise, there were no adverse events to include surgical-related mortality, recurrence of PDA, or need for chest tube placement during follow-up. SL of PDA in ELBW infants without chest tube placement is both efficient and safe. Universal consensus recommendations for the management of PDA in ELBW neonates are needed. Further study is required regarding the use of the less invasive option of percutaneous PDA closure in ELBW infants.

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Pre-Hospital and In-Hospital Thoracostomy: Indications and Complications

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x242286 ◽

2008 ◽

Vol 90 (1) ◽

pp. 54-57 ◽

Cited By ~ 60

Author(s):

Christopher J Aylwin ◽

Karim Brohi ◽

Gareth D Davies ◽

Michael S Walsh

Keyword(s):

Emergency Department ◽

Chest Tube ◽

Tension Pneumothorax ◽

Tube Placement ◽

Thoracic Injury ◽

Complication Rates ◽

Pleural Drainage ◽

Chest Tubes ◽

Chest Tube Placement ◽

Output State

INTRODUCTION Pleural drainage with chest tube insertion for thoracic trauma is a common and often life-saving technique. Although considered a simple procedure, complication rates have been reported to be 2–25%. We conducted a prospective cohort observational study of emergency pleural drainage procedures to validate the indications for pre-hospital thoracostomy and to identify complications from both pre- and in-hospital thoracostomies. PATIENTS AND METHODS Data were collected over a 7-month period on all patients receiving either pre-hospital thoracostomy or emergency department tube thoracostomy. Outcome measures were appropriate indications, errors in tube placement and subsequent complications. RESULTS Ninety-one chest tubes were placed into 52 patients. Sixty-five thoracostomies were performed in the field without chest tube placement. Twenty-six procedures were performed following emergency department identification of thoracic injury. Of the 65 pre-hospital thoracostomies, 40 (61%) were for appropriate indications of suspected tension pneumothorax or a low output state. The overall complication rate was 14% of which 9% were classified as major and three patients required surgical intervention. Twenty-eight (31%) chest tubes were poorly positioned and 15 (17%) of these required repositioning. CONCLUSIONS Pleural drainage techniques may be complicated and have the potential to cause life-threatening injury. Pre-hospital thoracostomies have the same potential risks as in-hospital procedures and attention must be paid to insertion techniques under difficult scene conditions. In-hospital chest tube placement complication rates remain uncomfortably high, and attention must be placed on training and assessment of staff in this basic procedure.

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A beneficial technique for preventing the device protrusion to the aorta during percutaneous patent ductus arteriosus closure: “Balloon-assisted device releasing technique”

Cardiology in the Young ◽

10.1017/s1047951119002269 ◽

2019 ◽

Vol 29 (11) ◽

pp. 1380-1386 ◽

Cited By ~ 1

Author(s):

Serdar Epçaçan ◽

Mustafa Orhan Bulut ◽

İlker Kemal Yücel ◽

Ahmet Çelebi

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Safe Procedure ◽

Disc Protrusion ◽

Surgical Interventions ◽

Significant Difference ◽

Patent Ductus Arteriosus Closure ◽

Group 2 ◽

Patent Ductus ◽

Group 1

AbstractBackground:Although percutaneous closure of patent ductus arteriosus is an established safe procedure, protrusion of the device to descending aorta may occur in various degrees during these procedures, especially in small infants. The aim of our study is to evaluate the benefits of balloon-assisted device releasing technique in the era of preventing device protrusion and conditions related to protrusion.Methods:One hundred and fifty-five infants, who underwent patent ductus arteriosus closure with Amplatzer duct occluder I device between January, 2012 and December, 2018, were retrospectively analysed. Balloon-assisted device releasing technique was used in 20 cases (group 1, 12.9%), between January, 2015 and December, 2018. Procedures in which the technique had been used were compared with the remaining ones (group 2, 87.1%, n = 135) with regard to device stabilisation, aortic disc protrusion to the aorta, iatrogenic coarctation, and device embolisation.Results:There was no significant difference by means of gender, age, weight, and the ductal diameter, whereas the average mean pulmonary artery pressure was significantly higher in group 1. Device protrusion and related complications were significantly higher in group 2; thus, additional catheterisations or surgical interventions were required, while no additional intervention was required in group 1.Conclusion:The balloon-assisted device releasing technique provides a good device stabilisation and prevents protrusion of the device and related complications during percutaneous patent ductus arteriosus closure in selected cases.

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Antenatal Magnesium Sulfate Exposure and Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants

American Journal of Perinatology Reports ◽

10.1055/s-0039-3400316 ◽

2019 ◽

Vol 09 (04) ◽

pp. e353-e356 ◽

Cited By ~ 2

Author(s):

Amna Qasim ◽

Sunil K. Jain ◽

Ashraf M. Aly

Keyword(s):

Patent Ductus Arteriosus ◽

Magnesium Sulfate ◽

Premature Infants ◽

Ductus Arteriosus ◽

Group Analysis ◽

Matched Group ◽

Increased Risk ◽

Significant Difference ◽

Baseline Characteristics ◽

Patent Ductus

Abstract Objective The use of antenatal magnesium sulfate (MgSO4) has been associated with neuroprotective effects. One of its' proposed mechanisms of action includes antagonism of calcium channels. Calcium influx is important for closure of ductus arteriosus. We hypothesized that antenatal MgSO4 exposure may be associated with an increased risk of hemodynamically significant patent ductus arteriosus (HsPDA) in premature infants (PI). Study Design A prospective cohort study conducted in two parts. PI (< 32 weeks and < 1,500 g) were recruited (n = 105). All infants had Echocardiograph (ECHO; within 3 days) and blood samples drawn at the same time for B-type natriuretic peptide (BNP; part 1) and NTproBNP (N-terminal pro BNP; part 2) measurements. HsPDA was defined as a PDA diameter > 1.5 mm and BNP levels > 40 pg/mL or NTproBNP > 10,200 pg/mL. Infants were divided into two groups based on antenatal MgSO4 exposure. Data were analyzed using SPSS 23. Difference in baseline characteristics and antenatal steroid use in the two groups was analyzed. A matched group analysis was performed to adjust for the difference in the numbers between the two groups. A p-value < 0.05 was considered significant. Results There was no significant difference seen in baseline characteristics or use of antenatal steroids in exposed versus unexposed (n = 95 vs. n = 10). There was a significant negative correlation between antenatal MgSO4 exposure and HsPDA in PI (p ≤ 0.05). However, this association was not significant after matched group analysis. Conclusion Antenatal MgSO4 exposure is not associated with an increased risk of HsPDA. It may be associated with a decreased likelihood of HsPDA.

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Circulating Prostaglandin E2 Concentrations and Incidence of Patent Ductus Arteriosus in Preterm Infants with Respiratory Distress Syndrome

PEDIATRICS ◽

10.1542/peds.66.5.725 ◽

1980 ◽

Vol 66 (5) ◽

pp. 725-729

Author(s):

Ronald I. Clyman ◽

Claire Brett ◽

Françoise Mauray

Keyword(s):

Patent Ductus Arteriosus ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Prostaglandin E2 ◽

Preterm Infants ◽

Distress Syndrome ◽

Ductus Arteriosus ◽

The Third ◽

Significant Difference ◽

Patent Ductus

In several species prostaglandin E2 (PGE2) appears to be the most important prostanoid to regulate patency of the ductus arteriosus. We measured the arterial plasma concentration of PGE2 in 29 premature infants (17 with respiratory distress syndrome alone and 12 with respiratory distress syndrome and patent ductus arteriosus) to determine if there was an association between circulating PGE2 and patent ductus arteriosus. The PGE2 concentrations during the first two days after birth were higher than PGE2 concentrations after the third postnatal day (17.1 ± 3.1 pg/ml, mean ± SEM, n = 23, vs 6.12 ± 0.63 pg/ml, n = 19, P < .005). By the third postnatal day, arterial concentrations were similar to adult venous values. There was no significant difference between the plasma PGE2 concentrations in the 12 infants with patent ductus arteriosus and the concentrations in the 17 infants who had no signs of patent ductus arteriosus. These findings do not support the hypothesis that an increased concentration of circulating PGE2 is the primary cause for the persistent patency of the ductus arteriosus in preterm infants with respiratory distress syndrome.

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Neurodevelopmental Outcomes of Preterm Infants Treated with Oral Paracetamol Versus Ibuprofen for Patent Ductus Arteriosus

American Journal of Perinatology ◽

10.1055/s-0037-1601564 ◽

2017 ◽

Vol 34 (12) ◽

pp. 1185-1189 ◽

Cited By ~ 11

Author(s):

Zeynep Eras ◽

Nurdan Uras ◽

Fuat Canpolat ◽

Omer Erdeve ◽

Serife Oguz ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Infant Development ◽

Controlled Trial ◽

Ductus Arteriosus ◽

Neurodevelopmental Outcomes ◽

Significant Difference ◽

Oral Ibuprofen ◽

Patent Ductus

Objective This study aims to determine the effects of paracetamol versus ibuprofen treatment given to preterm infants for the pharmacological closure of patent ductus arteriosus (PDA) on neurodevelopmental outcomes at 18 to 24 months' corrected age. Method A follow-up study was conducted to evaluate the neurodevelopmental outcomes of preterm infants (gestational age ≤ 30 weeks) enrolled in a randomized controlled trial comparing oral paracetamol versus oral ibuprofen for the closure of PDA. The developmental assessment was done by using “Bayley Scales of Infant Development, Second Edition” at 18 to 24 months' corrected age. Results A total of 80 infants completed the trial protocol. Of the 75 infants eligible for follow-up, 61 infants (30 in the paracetamol group and 31 in the ibuprofen group) were evaluated. There was no significant difference in neurodevelopmental outcomes between the two groups. Conclusion The neurodevelopmental outcomes did not differ among the preterm infants who receive either paracetamol or ibuprofen at 18 to 24 months' corrected age.

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P018 RENAL adverse events and gastrointestinal bleeding with ibuprofen use in preterm neonates with patent ductus arteriosus (PDA)

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-nppc.28 ◽

2019 ◽

Vol 104 (7) ◽

pp. e2.21-e2

Author(s):

Asma Al-Turkait ◽

Janine Abramson ◽

Imti Choonara ◽

Lisa Szatkowski ◽

Shalini Ojha

Keyword(s):

Adverse Events ◽

Patent Ductus Arteriosus ◽

Serum Creatinine ◽

Cohort Studies ◽

Systematic Reviews ◽

Ductus Arteriosus ◽

Preterm Neonates ◽

Gi Bleeding ◽

Significant Difference ◽

Patent Ductus

AimTo identify all the reported adverse events associated with ibuprofen use in preterm neonates for PDA closure and quantify the risk per 100 patients.MethodsWe followed the Cochrane standards for conducting systematic reviews of adverse events.1 Eight electronic databases [Embase, Medline, BNI, PubMed, Cochrane library, IPA, CINAHL, clinical trials.gov] were searched to identify relevant studies using a predetermined search strategy. Published conference abstracts, grey literature, and reference lists of the retrieved articles were also searched. All studies providing information on adverse events of ibuprofen in preterm neonates with PDA were included. Following quality assessment of the retrieved studies, meta-analysis was performed to pool the results from the RCTs using Rev man 5.3 software. Results of the observational studies are descriptively reported and analysed. Protocol registered in PROSPERO (CRD42018067600).ResultsThe complete adverse events systematic review includes 84 studies (38 RCTs, 10 case reports, 4 case series, 31 cohort studies and 1 case-control study). The majority of adverse events were captured in retrospective cohort studies. Gastrointestinal (GI) bleeding: Pooled results from RCTs that compared ibuprofen to placebo showed significant difference RR [95% CI]: 1.99[1.13, 3.50] favouring placebo. Similarly, compared to paracetamol, ibuprofen was also associated with an increased risk of GI bleeding RR [95% CI]: 7.00[1.91, 25.61]. There was no significant difference in GI bleeding when comparing ibuprofen to indomethacin RR [95% CI]; 0.98[0.48, 2.00]. Renal adverse events: Data from RCTs showed that ibuprofen had a significantly low risk of oliguria compared to indomethacin RR [95% CI]: 0.38[0.25, 0.56]. However, no difference in risk of oliguria was found when comparing ibuprofen to paracetamol RR [95% CI]: 2.16[0.91, 5.11]. Serum creatinine levels after ibuprofen treatment compared to placebo was reported by 4 RCTs with favourable results to placebo MD [95% CI]; 8.66 [5.17, 12.15]. The risk of adverse events per 100 patients who received ibuprofen from data from prospective studies was 8.9 for GI bleeding, 7.6–7.8 for oliguria, 5.2 for rise in serum creatinine and 2.6 for renal failure. Increase in serum creatinine after treatment was most commonly reported in retrospective cohort studies (460 cases out of 1786 adverse events). Nine cases of GI bleeding led to discontinuation of ibuprofen treatment.ConclusionOur meta-analysis of the RCT data supported results of previous systematic reviews.2 3 Combined results from RCTs and prospective cohort studies in our review show that oliguria is the most commonly reported adverse event among the renal adverse events. However, the high number of rising serum creatinine after treatment from retrospective studies should also be considered when treating preterm neonates with ibuprofen for PDA. Paracetamol might be favoured as it associated with less risk of GI bleeding when compared to ibuprofen.ReferencesLoke Y.K, Price D., Herxheimer A., et.al. Systematic reviews of adverse effects: framework for a structured approach. BMC Med Res Methodol 2007 July 5;7:32.Ohlsson A., Walia R., Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database of Systematic Reviews, 2015, Issue 2. Art. No.: CD003481. doi: 10.1002/14651858.CD003481.pub6Ohlsson A., Shah SS. Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database of Systematic Reviews, 2011, Issue 7. Art. No.: CD004213. doi:10.1002/14651858.CD004213.pub3Save

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Consensus Guidelines for the Prevention and Management of Periprocedural Complications of Transcatheter Patent Ductus Arteriosus Closure with the Amplatzer Piccolo Occluder in Extremely Low Birth Weight Infants

Pediatric Cardiology ◽

10.1007/s00246-021-02665-3 ◽

2021 ◽

Author(s):

Shyam Sathanandam ◽

Dan Gutfinger ◽

Brian Morray ◽

Darren Berman ◽

Matthew Gillespie ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Extremely Low Birth Weight ◽

Complication Rates ◽

Consensus Guidelines ◽

Low Birth Weight Infants ◽

Management Options ◽

Patent Ductus

AbstractTranscatheter closure of patent ductus arteriosus (PDA) in premature infants is a feasible, safe, and an effective alternative to surgical ligation and may be performed with an implant success rate of 97%. Major procedural complications related to transcatheter PDA closure in extremely low birth weight (ELBW) infants are relatively infrequent (< 3%) ,but may be associated with a fatality if not optimally managed. Operators performing transcatheter PDA closures should be knowledgeable about these potential complications and management options. Prompt recognition and treatment are often necessary to avoid serious consequences. With strict guidelines on operator training, proctoring requirements, and technical refinements, transcatheter PDA closure in ELBW infants can be performed safely with low complication rates. This article summarizes the consensus guidelines put forward by a panel of physicians for the prevention and management of periprocedural complications of transcatheter PDA closure with the Amplatzer Piccolo Occluder in ELBW infants.

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Intracardiac Echocardiography as a Guide for Transcatheter Closure of Patent Ductus Arteriosus

Journal of Interventional Cardiology ◽

10.1155/2020/5147193 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Hironaga Yoshimoto ◽

Maeda Yasuto ◽

Tadashi Inoue ◽

Yoshiyuki Kagiyama ◽

Yozo Teramachi ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Transcatheter Closure ◽

Phase 1 ◽

Ductus Arteriosus ◽

Intracardiac Echocardiography ◽

Poor Correlation ◽

Phase 2 ◽

Contrast Volume ◽

Significant Difference ◽

Patent Ductus

Background. Transcatheter closure of patent ductus arteriosus (TC-PDA), conventionally guided by aortography, has become the standard treatment of this disease. The purposes of this study were to evaluate whether intracardiac echocardiography (ICE) may be used for measuring PDA size and be used as a guide for TC-PDA. Methods. This study had 2 phases. In phase 1, we compared the measurements of PDA size: pulmonary artery side diameter (PA-D), length, and aortic side diameter (Ao-D) of PDA, as measured by ICE with those measured by aortography or cardiac computed tomography (AoG/CCT) in 23 patients who underwent TC-PDA. In phase 2, we compared the demographics, fluoroscopic time, contrast volume, and complications of the TC-PDAs between 10 adult patients with ICE guidance and 16 without it. Results. In phase 1, we found great correlation and agreement between ICE and AoG/CCT in PA-D (r = 0.985, bias −0.077 to 0.224), but moderate to poor correlation and agreement in length (r = 0.653, bias −0.491 to 3.065) and Ao-D (r = 0.704, bias 0.738 to 4.732), respectively. Nevertheless, all patients underwent successful TC-PDA with ICE guidance that allowed us to continuously monitor the whole process. In phase 2, TC-PDA required a significantly lower contrast volume with ICE guidance than without it, and there was no significant difference in the remaining variables between the 2 groups. Conclusion. ICE is comparable to AoG/CCT in providing accurate PA-D of the PDA and may be a safe alternative to guide TC-PDA as compared to conventional aortography.

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Transthoracic Needle Biopsy of Pulmonary Nodules: Meteorological Conditions and the Risk of Pneumothorax and Chest Tube Placement

Journal of Clinical Medicine ◽

10.3390/jcm8050727 ◽

2019 ◽

Vol 8 (5) ◽

pp. 727 ◽

Cited By ~ 1

Author(s):

Bedros Taslakian ◽

Varshaa Koneru ◽

James S. Babb ◽

Divya Sridhar

Keyword(s):

Chest Tube ◽

Needle Biopsy ◽

Pulmonary Nodules ◽

Meteorological Variables ◽

Tube Placement ◽

Smoking History ◽

P Value ◽

Transthoracic Needle Biopsy ◽

Chest Tube Placement ◽

Significant Difference

The purpose of this paper is to evaluate whether meteorological variables influence rates of pneumothorax and chest tube placement after percutaneous transthoracic needle biopsy (PTNB) of pulmonary nodules. A retrospective review of 338 consecutive PTNBs of pulmonary nodules at a single institution was performed. All procedures implemented a coaxial approach, using a 19-gauge outer guide needle for access and a 20-gauge core biopsy gun with or without a small-gauge aspiration needle for tissue sampling. Correlation between age, sex, smoking history, lesion size, meteorological variables, and frequency of complications were evaluated. Fisher exact, trend and t tests were used to evaluate the relationship between each factor and rates of pneumothorax and chest tube placement. A p value of less than 0.05 was considered to indicate a statistically significant difference. Pneumothorax occurred in 115 of 338 patients (34%). Chest tube placement was required in 30 patients (8.9%). No significant relationship was found between pneumothorax rate and age (p = 0.172), sex (p = 0.909), smoking history (p = 0.819), or lesion location (p = 0.765). The presence or absence of special weather conditions did not correlate with the rate of pneumothorax (p = 0.241) or chest tube placement (p = 0.213). The mean atmospheric temperature (p = 0.619) and degree of humidity (p = 0.858) also did not correlate with differences in the rate of pneumothorax. Finally, mean atmospheric pressure on the day of the procedure demonstrated no correlation with the rate of pneumothorax (p = 0.277) or chest tube placement (p = 0.767). In conclusion, no correlation is demonstrated between the occurrence of pneumothorax after PTNB of pulmonary nodules and the studied meteorological variables.

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