A Single Centre Study of Various Open Surgical Procedures For Isolated Patent Ductus Arteriosus – 6 Years Experience of 768 Cases
Journal Title: Stanley Medical Journal - Year 2017, Vol 4, Issue 1
Abstract
Context:Right from the day of first successful ligation of Patent Ductus Arteriosus (PDA) in 1938 by Robert Gross, various surgical techniques evolved so far to tackle PDA including video -assisted thoracoscopic and Robotic surgery. Simultaneously, transcatheter device closure and early pharmacological means of closure were achieved. But, still the mainstay of treatment for PDA practiced in most centres is various forms of open surgical therapy only (haem-clip application, ligation and/or division)Aims:We aim to study the standards for comparison and analyse the outcome of various open surgical techniques for isolated patent ductus arteriosus. Settings and Design:768 consecutive cases of Isolated PDA, operated between June 2006 and May 2012 with 6 months follow-up constituted the sample for this study in the Department of Paediatric Cardiothoracic Surgery, Institute of Child Health & Hospital for Children Egmore, Chennai and Department of Cardiovascular & Thoracic Surgery, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai. Study design :Prospective observational study. Methods and Material:Patients with severe pulmonary hypertension, Eisenmenger’s Syndrome, associated co -morbid conditions and selected primarily for pharmacological and transcatheter management were excluded. The timing and choice of surgical procedure (ligation/ haem-clip/division or combination and patch closure) was decided based on the grading of PDA and individual surgeon’s expertise and preference. Basic investigations include x-ray chest, ECG and echocardiography. Statistical analysis used:Descriptive statistical analysisResults:Statistical analysis done with postoperative follow-up at 1, 3 and 6 months. Mortality was 0.26% and morbidity at 16%, being low over time. Blood transfusion requirement stood at 2.08%. Length of hospital stay was 7 ± 2 days. PDA recurrence rate was 7.81%. The results were comparable with international studies.Conclusions: Data revealed our institution relatively as a high volume centre. We recommend clip application alone as a safe procedure in preterm babies and young infants (with friable and short PDA). Division, the gold standard for PDA closure when compared to ligation as the recurrence rate is nil. Surgeons need to expertise themselves technically and in decision-making to achieve better results
Authors and Affiliations
Amaravathi Sivaraman, Srinivasan Thiruneelakandan, Perumal Moorthy
Keywords
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