Results
Twenty-seven patients with a mean (±SD) gestational age of 25.8 (±2.0) weeks and a mean birth weight of 1027 (±423) g were operated using left anterior mini-thoracotomy technique. Eighteen were females (66 %), 9 were males (33 %). 17 (62 %) were born at ≤26 weeks and 17 were ≤ 1000 g. According to their weight at the time of operation the patients were seperated into two groups: Group 1≤ 1000 g (n: 13) and Group 2 > 1000 g (n: 14). Mean weight of all the patients on operation day was 1188 (±553) (480-2700 g). In Group 1 it was 822 (±169) g and in Group 2 it was 1528 (±573) g. Statistically difference was significant between Group 1 and 2 : 822 (±169) g, 1528 (±573) g, respectively( p: 0.000). Mean age of all the patients on operation day was 29,7 ± 16,1 days. In Group 1 it was 23 (±12) and in Group 2 it was 36 (±20) days, respectively (p: 0.079). Statistically difference was not significant between Group 1 and 2. Each group had some limitations as all the patients in group 1 were very-low birht weight, 7 patients in group 2 were very-low birth weight. All of the cases were completed without cardiopulmonary bypass. There was no blood loss during the cases, no surgery related mortality or no significant difference in operation time between the cases. As the patients had no drainage tube, they had no drainage after the operation. Complications such as bleeding, abnormal healing of incision or pneumothorax were not seen. Patients’ preoperative conditions were analyzed in Table 2. Additional comorbidities of the patients before the surgery were 8 bacterial sepsis (29,6 %), 3 necrotizing enterocolitis(11 %),1 hydrocephalus (0,3 %), 4 intracranial hemorrhage (14,8%). All of the patients had congestive heart failure and five had a pulmonary infection. A clip was placed on the PDA in 16 patients and PDA was ligated with a 2‐0 silk suture in 11 patients. Mean operation time was 18.7 (±5.5) minutes (range, 10-40 minutes). After a day of postoperative follow-up we sent the patients back to centers they came from. We transferred all the 13 patients back to centers they came from. The remaining patients’ postoperative mean mechanical ventilatory support time was 29.5 (±42.6) days (range, 1-165 days), mean hospital stay was 71.5 (±56.0) days (range, 7-193 days) and the mean postoperative length of stay was 47.4 (±44.2) days (range, 6-165 days). There were 8 mortalities after the operation (29,6 %). Five were due to sepsis, one was due to necrotizing enterocolitis, one was due to hydrops fetalis and one was due to renal failure with hepatoblastoma. There was no internal thoracic artery injury or no need for conversion to thoracotomy or sternotomy. All patients except one were ventilator-dependent before surgery. That patient had rapidly progressive renal failure before the surgery. There were 16 (59%) postoperative complications (8 in Group 1 and 8 in Group 2) during intensive unit care stay. In addition, there were 6 (22%) deaths in the postoperative first 30 days and 4 (14,8%) deaths between the postoperative first month and first year. The cause of the deaths were sepsis, NEC, hydrops fetalis, hepatoblastoma and intracranial bleeding. Left diaphragmatic elevation developed in 1 patient, and plication was performed. Three percent (one patient) of all patients needed reoperation because of a significant residual  patent ductus arteriosus. This patient was reoperated on postoperative day 1 through the same thoracotomy incision. Other residual shunt closed spontaneously. 17 of all patients are still alive (Table 3).