Cierre quirúrgico del ductus arterioso persistente del prematuro: ¿influye la técnica quirúrgica en los resultados? / Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

INTRODUCCIÓN: El cierre quirúrgico del ductus arterioso persistente en el prematuro es una técnica agresiva y no exenta de complicaciones. Diseñamos un estudio con el objetivo de describir nuestra experiencia con una técnica menos invasiva, el abordaje extrapleural vía minitoracotomía posterior, y de comparar sus resultados con los del abordaje clásico transpleural. PACIENTES Y MÉTODOS: Estudio de cohortes retrospectivo de los neonatos prematuros a los que se les realizó cierre quirúrgico del ductus en un periodo de 10 años (marzo de 2005-marzo de 2015). Se compararon las complicaciones agudas, los resultados al alta y en el seguimiento entre los grupos de abordaje extrapleural y abordaje clásico transpleural. Se incluyó a 48 pacientes, 30 en el grupo de abordaje clásico y 18 en el grupo extrapleural. RESULTADOS: Las características demográficas y preoperatorias fueron similares en ambos grupos. No se encontraron diferencias entre los 2 grupos en la incidencia de complicaciones postoperatorias agudas (56,6 vs. 44,4%), en la dependencia de oxígeno a las 36 semanas (33,3 vs. 55,5%), ni en la mortalidad hospitalaria (10 vs. 16,6%). En la evolución a corto plazo, el grupo extrapleural precisó menos días hasta la retirada del oxígeno suplementario (36,3 vs. 28,9) y hasta el alta hospitalaria (67,5 vs. 53,2), aunque solo el tiempo hasta la extubación alcanzó una diferencia estadísticamente significativa (11,5 vs. 2,7, p = 0,03). CONCLUSIONES: El abordaje extrapleural por minitoracotomía posterior para el cierre quirúrgico del ductus en el prematuro es factible y podría conllevar algunos beneficios clínicos a corto plazo

INTRODUCTION: Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. PATIENTS AND METHODS: A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. RESULTS: The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). CONCLUSIONS: The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term

[Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?] / Cierre quirúrgico del ductus arterioso persistente del prematuro: ¿influye la técnica quirúrgica en los resultados?

INTRODUCTION: Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. PATIENTS AND METHODS: A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. RESULTS: The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). CONCLUSIONS: The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term.