Fourty-Six Years of Patent Ductus Arteriosus Division at Childrenʼs Memoreal Hospital of Chicago

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Abstract
The authors reviewed a large surgical experience (during five decades) with ligation and division of patent ductus arteriosus (PDA) in light of previously reported historical standards and present-day alternatives. Ligation of PDA was first performed by Gross in 1938. Various surgical techniques used since then have included ligation and division, simple ligation, and hemaclip application. Recently introduced therapies include percutaneous transcatheter ductal closure devices (PTDC) and video-assisted thoracotomy (VAT). Percutaneous transcatheter ductal closure device protagonists cite surgical recurrence rates as high as 22% to justify continued application. Between 1947 and 1993, 98.2% of 1108 patients (premature babies excluded) had interruption of PDA by ligation and division. Recent improvements have included muscle-sparing thoracotomy, minimal use of tube thoracostomy, and same-day surgery. Mortality was zero and morbidity (4.4%) has been low over time. Mean age at surgery has decreased from 5.9 +/- 3.3 years to 3.6 +/- 3.8 years (p < 0.001); patients requiring blood transfusion decreased from 34% to 4.6% (p < 0.001); and length of hospital stay (LOS) has decreased from 12.1 +/- 2.9 days to 3.8 +/- 2.1 days (p < 0.001). Length of stay for the last 27 patients was 2.8 +/- .8 days. Patient ductus arteriosus recurrence rate is zero with this technique. Recurrence rates for PTDC are high with as yet unknown consequences of large catheter vascular access, endocarditis, or left pulmonary artery stenosis. Video-assisted thoracotomy for PDA interruption has the potential for uncontrolled exsanguinating hemorrhage. Open thoracotomy for PDA ligation and division can be performed safely and without recurrence through a muscle-sparing incision with short LOS. All other therapeutic interventions must be compared to these standards.