VIDEO-ASSISTED THORACOSCOPIC SURGERY VERSUS OPEN THORACOTOMY FOR

VASCULAR RING ANOMALY IN PEDIATRIC PATIENTS

OBJECTIVE: The use of video-assisted thoracoscopic surgery (VATS) is becoming

increasingly common in the treatment of congenital heart defects, particularly for the
division of vascular rings. We compare the short-term outcomes of vascular ring
division by VATS and compared this approach with conventional open thoracotomy.
METHODS: This study is a retrospective review of patients with double aortic arch or
right aortic arch with aberrant left subclavian artery and left ligamentum who
underwent division via left thoracotomy or VATS approach at a single institution
between November 1999 and October 2019. We analyzed patient demographics,
preoperative clinical symptoms, diagnostic imaging modality, type of surgery,
operative time, early complications and symptom resolution.
RESULTS: A total of 17 patients underwent vascular ring division by VATS (n =5) or
thoracotomy (n = 12) were analized. Median age was 5.7 years (range: 1.7-9.7 years) in
the thoracoscopic group and 2.3 years (range: 1 month- 14 years) in the open group
(p=0.61). Median weight was 18.1 Kg (range: 9-26.8 Kg) in the thoracoscopic group and
11.4 Kg (range: 3- 54 Kg) in the open group (p=0.83). The thoracoscopic group did not
differ in preoperative symptoms with the open group. The operative time was shorter
in the thoracoscopic group (65.4±11.9 vs 180.5± 51.2; p=0.05) and all patients were
extubated in the operating room. The complications in the open group were
chylothorax (n=3), pulmonary complications (n=2), dysphonia (n=1), esophageal
perforation (n=1) and recurrent urinary tract infection (n=1). In the thoracoscopic
group, only one case of mild left subcutaneous emphysema was observed. There was
no significant difference in the intensive care unit stay (1.2±0.4 vs 1.5± 0.8; p=0.13)
however, the total length of stay was shorter in the thoracoscopic group (3.4±0.5 vs
13.8±17.9; p=0.04). At follow-up visit within one month after surgery, most patients
(100% vs 92%) reported improvement in symptoms.
CONCLUSIONS: Video-assisted thoracoscopic division of vascular rings in pediatric
patients is a feasible alternative to division by thoracotomy and is associated with
shorter operative duration and decreased length of hospital stay and chylothorax.