Experience of video-assisted thoracic surgery treatment of congenital pulmonary airway malformation in infants less than 3 months of age.

Background: Congenital pulmonary airway malformation (CPAM) is the most common type of congenital lung malformation, some children were born with serious respiratory and circulatory disorders, these children tend to have larger cystic lesions and emergency surgery should be taken after birth. This article aimed to explore the feasibility of video-assisted thoracic surgery (VATS) for CPAM in infants less than 3 months of age and analyze the early and mid-term postoperative outcomes. Methods: A retrospective analysis was performed on 12 children with CPAM who were admitted to Shanghai Children's Hospital from January 2019 to December 2022. Among them, there were ten boys and two girls. The age ranged from 13 to 89 days, with an average of 60.09±30.13 days. The body weight ranged from 2.8 to 7.5 kg, averaging 5.12±1.56 kg. All patients had severe respiratory symptoms such as persistently tachypneic, recurrent pneumonia or respiratory failure. Results: All of the included children underwent VATS with no cases converted to thoracotomy. The operation time ranged from 40 to 190 minutes, with an average of 124.17 minutes. Among the children in this study, ten cases underwent lobectomy; one underwent segmental resection; one underwent irregular resection. Postoperative mechanical ventilation time ranged from 3 to 49 hours, with an average of 12.75 hours. The indwelling time of the thoracic drainage tube ranged from 2 to 9 days, with an average of 3.92 days. The postoperative hospital length of stay ranged from 5 to 12 days, averaging 8.42 days. None of the children had postoperative complications such as bleeding, bronchopleural fistula or atelectasis. The follow-up time ranged from 3 months to 4 years, and all the children were discharged within 12 days of postoperative hospitalization without need for readmission. Furthermore, no residual lesions were found in the reexamined chest computerized tomography (CT), the lung inflammation dissipated, and no residual cavity was in the affected chest. Conclusions: Infants with symptomatic CPAM less than 3 months of age should be operated on as soon as possible. With the improvement of minimally invasive technology and anesthesia management, VATS is relatively safe and effective in treating children with such conditions.