SURGICAL TECHNIQUE ___________________________________________________________ Closure of a Patent Ductus Arteriosus in Pre-Term Neonates Using a Left Anterior Mini-Thoracotomy Ali Riza Karaci, M.D.,* Ahmet Sasmazel, M.D.,* Saritas Turkay, M.D.,y Numan Aydemir, M.D.,* Harmandar Bugra, M.D.,* Hasan Erdem, M.D.,z and Yekeler Ibrahim, M.D.* *Cardiovascular Surgery Clinic, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, HaydarpaS sa, _ Istanbul, Turkey; yPediatric Cardiology Clinic, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, HaydarpaS sa, _ Istanbul, Turkey; and zCardiovascular Surgery Clinic, Kartal Kosuyolu Heart and Research Center, Kartal, _ Istanbul, Turkey ABSTRACT Objectives: We present a surgical technique for closure of a patent ductus arteriosus (PDA) in pre- term neonates. Left anterior mini-thoracotomy is a surgical procedure that consists of an anterior mini- thoracotomy (1.5 cm) below the clavicle, clipping the PDA, and closing the thorax without a tube thoracotomy. Methods: Using this method between 2009 and 2012, we performed PDA closure in 32 pre-term neonates. Logistic regression analysis of potential risk factors for mortality was determined. Results: The mean weight of the patients at the operation was 822.81 W 24.59. The mean age at the operation was 28.97 W 2.20 days. No surgery-related mortalities occurred. Four short-term mortalities occurred after the operation (12.5%) before the patients could be discharged. Three were due to sepsis, and one was due to necrotizing enterocolitis. According to the linear regression analysis, no other variables were found to be statistically significant for predicting mortality. A negative linear correlation was found between the weight of the patients at the operation and extubation time (p = 0.39; r = S0.39). Conclusion: The surgical outcome of anterior mini-thoracotomy for PDA closure in neonates is compatible with good results. This technique may be advantageous for extremely low birth weight infants and results in less traction on the lungs. doi: 10.1111/jocs.12135 (J Card Surg 2013;28:461–464) Patent ductus arteriosus (PDA) is the most frequently seen congenital cardiac lesion in premature infants. 1 The first successful surgical closure of a PDA was done by Gross and Hubbard nearly seven decades ago 2 and its closure has become the standard surgical interven- tion in premature infants in the past 30 years. 3 Several surgical techniques have been advocated for closure of a PDA. Most surgeons have focused on muscle-sparing and short incisions to facilitate better chest growth. These techniques have been applied in premature infants with few complications. 4 Most of the surgical techniques for closure of a PDA are through a lateral, posterolateral or axillary thoracot- omy. In the past three years, we have closed PDAs through a mini-thoracotomy below the clavicle without chest tube drainage in premature infants. In this review, we report our results with this technique. MATERIALS AND METHODS Patient selection criteria Thirty-two consecutive patients undergoing surgery for premature infant PDA closure were evaluated in this retrospective study during the period of March 2009 to December 2012. All of the patients were pre-term neonates. Infants who required concomitant proce- dures or who were not premature at birth were excluded from this study. The surgical indications for closure of a PDA in a premature infant were those who either remained in congestive heart failure despite medical management or showed a large left-to-right shunt on echocardio- grams. All patients had either failed attempts at medical closure with ibuprofen (n ¼ 27) or had contraindications to its use (n ¼ 5). Nineteen (59%) operations were Conflict of interest: The authors acknowledge no conflict of interest in the submission. Address for correspondence: Ahmet Sasmazel, Cardiovascular Sur- gery Clinic, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, HaydarpaS sa, _ Istanbul, Turkey. Fax: 90-216-337-97-19; e-mail: sasmazel@yahoo.com © 2013 Wiley Periodicals, Inc. 461