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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 evaluate our outcomes of vascular ring division by VATS, compare them to our outcomes of those operations performed by standard open thoracotomy, and discuss new issues raised by VATS division of vascular rings.
Methods: From 2001 to 2004, 47 pediatric patients underwent division of a vascular ring. Division was attempted by the thoracoscopic approach in 16 patients. We reviewed pre-operative, operative, and post-operative data. Comparisons were made between operations performed by open thoracotomy and by video-assisted thoracosopic surgery.
Results: For the 47 patients, diagnoses were as follows: right aortic arch/aberrant left subclavian artery/ligamentum arteriosum (25), double aortic arch/right dominant (19), double aortic arch/left dominant (3). Ages ranged from 1.4 to 207 months (median 15.0) and weights ranged from 2.8 to 40.3 kg (median 10.0). Thoracoscopic division was successful in 14/16 (88%) patients. There was no significant difference in the procedure time (p=0.091) between techniques, but there was a significant reduction in ICU stay (p=0.012) and total length of hospital stay (p=0.007) with the thoracoscopic approach.
Conclusions: The division of vascular rings by video-assisted thoracoscopic surgery shows favorable outcomes compared to the open thoracotomy approach. Hopefully, with an increase in comfort level and further improvements in technology, the use of the thoracoscope can be extended to include patients with other congenital heart defects.