Background: Patent ductus arteriosus (PDA) occurs more frequently in premature infants. Depending on the degree of prematurity, these children often have other serious comorbidities that could significantly impact on surgical outcome. Aim: This study aimed to evaluate clinical results of the surgical ligation of PDA in extremely low body weight preterm infants with birth weight below 750 grams and to identify risk factors of mortality. Methods: A total of 31 preterm infants with birth weight below 750 grams and significant PDA were operated between 2006 and 2016 through posterolateral thoracotomy (n=16) or with the use of video-assisted thoracoscopic (VATS) method (n = 15). Mean weight at the time of surgery was 750.8 ± 104.7 g. The gestational age ranged from 22 to 32 weeks. Data were retrospectivel1y analyzed and prospective 100% follow-up was performed. Results: In-hospital mortality was 25.8% (n = 8). Type of surgery had no influence on the results. During the follow-up period lasting 5.2 ± 2.5 years two other patients died. One-year and 5-year probability of survival was 77.4% and 74.2%, respectively. The predominant cause of death was acute heart failure. All patients with preoperative renal dysfunction died in the postoperative period. Moreover, Cox regression analysis revealed renal dysfunction as an independent risk factor of early death. Conclusions: Preterm infants with birth weight less than 750 grams and significant PDA are highly challenging patients. Despite the recent advances in perioperative management with neonates, surgery is still associated with high early mortality rate irrespective of applied method. Background: Patent ductus arteriosus (PDA) occurs more frequently in premature infants. Depending on the degree of prematurity, these children often have other serious comorbidities that could significantly impact on surgical outcome. Aim: This study aimed to evaluate clinical results of the surgical ligation of PDA in extremely low body weight preterm infants with birth weight below 750 grams and to identify risk factors of mortality. Methods: A total of 31 preterm infants with birth weight below 750 grams and significant PDA were operated between 2006 and 2016 through posterolateral thoracotomy (n=16) or with the use of video-assisted thoracoscopic (VATS) method (n = 15). Mean weight at the time of surgery was 750.8 ± 104.7 g. The gestational age ranged from 22 to 32 weeks. Data were retrospectivel1y analyzed and prospective 100% follow-up was performed. Results: In-hospital mortality was 25.8% (n = 8). Type of surgery had no influence on the results. During the follow-up period lasting 5.2 ± 2.5 years two other patients died. One-year and 5-year probability of survival was 77.4% and 74.2%, respectively. The predominant cause of death was acute heart failure. All patients with preoperative renal dysfunction died in the postoperative period. Moreover, Cox regression analysis revealed renal dysfunction as an independent risk factor of early death. Conclusions: Preterm infants with birth weight less than 750 grams and significant PDA are highly challenging patients. Despite the recent advances in perioperative management with neonates, surgery is still associated with high early mortality rate irrespective of applied method.

Background/Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) surgery, performed through a left minithoracotomy, has emerged as an alternative to conventional coronary artery bypass grafting (CABG), which requires a full sternotomy. This procedure is ideal for patients with isolated proximal left anterior descending (LAD) artery disease or high surgical risk. The aim of this study was to assess the long-term clinical outcomes of MIDCAB performed at a single center with stratification by revascularization strategy. Methods: A total of 480 patients who underwent off-pump MIDCAB between 2012 and 2024 at a single center were retrospectively analyzed and categorized into three distinct groups: complete revascularization (MIDCAB-CR), hybrid coronary revascularization (MIDCAB-HCR) and incomplete revascularization (MIDCAB-IR). Short- and long-term outcomes, including mortality, major adverse cardiac and cerebral events (MACCE) and LITA–LAD graft patency were evaluated. Median follow-up was 3.39 years. Results: In-hospital mortality was 1.4%. At a median follow-up duration of 3.39 years, the overall LITA–LAD graft patency was 94.4% with 5- and 10-year survival rates of 78% and 60%, respectively. MIDCAB-CR and MIDCAB-HCR groups showed comparable long-term survival and freedom from MACCE, both significantly better than those observed in the MIDCAB-IR groups. Conclusions: These findings support the safety and durability of MIDCAB as an effective revascularization strategy, especially when performed as complete or hybrid revascularization. Incomplete revascularization may be considered in selected high-risk patients but is associated with worse outcomes.