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Maltezeanu A, Aldriweesh B, Chan CY, Fayoux P, Bernier PL, Daniela da Silva S, Daniel SJ. Slide tracheoplasty for congenital tracheal stenosis: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 182:111993. [PMID: 38885545 DOI: 10.1016/j.ijporl.2024.111993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Slide tracheoplasty has become the gold standard surgery for congenital tracheal stenosis (CTS). This condition is rare and the surgery can be challenging and is performed by experienced surgeons in tertiary centers. A few reports involving relatively small cohorts have been published. The aim of this review is to evaluate the post-operative mortality and morbidity of pediatric slide tracheoplasty for CTS. METHODS A systematic literature review was performed according to PRISMA guidelines. The Medline and EMBASE databases were screened using a search strategy defined in collaboration with a librarian. We included articles reporting the post-operative mortality rate of slide tracheoplasties for treatment of CTS in children, when at least 10 patients were included. RESULTS A total of 932 articles were reviewed, and 15 studies were eligible with a total of 845 patients. The overall post-operative mortality rate was 9.3 %, and most deaths were airway related. The open revision surgery rate after surgery was 2.8 % and the endoscopic revision rate was 27.6 %. DISCUSSION This study highlights key factors to consider before the surgery and helps anticipate post-operative follow-up considerations for children with CTS. Several factors were identified as predictors of mortality including young age, weight at the time of surgery and association with lung hypoplasia or aplasia. CONCLUSION Although slide tracheoplasty has gained popularity in recent years due to better outcomes, it remains a major surgery with mortality risk and the need for multidisciplinary management.
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Affiliation(s)
- Alix Maltezeanu
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Department of Pediatric Otolaryngology, Faculty of Medicine - Jeanne de Flandre Hospital, Lille, France
| | - Bshair Aldriweesh
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology-Head & Neck Surgery, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Ching Yee Chan
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada; Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology, Faculty of Medicine - Jeanne de Flandre Hospital, Lille, France
| | - Pierre-Luc Bernier
- Department of Pediatric Cardiothoracic Surgery, Faculty of Medicine - McGill University, Montreal, QC, Canada
| | - Sabrina Daniela da Silva
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Sam J Daniel
- Division of Otolaryngology-Head and Neck Surgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
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Liu Y, He Q, Dou Z, Ma K, Chen W, Li S. Management Strategies for Congenital Heart Disease Comorbid with Airway Anomalies in Children. J Pediatr 2024; 264:113741. [PMID: 37726085 DOI: 10.1016/j.jpeds.2023.113741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To assess management strategies for pediatric patients with the challenging combination of congenital heart diseases (CHDs) and airway anomalies. STUDY DESIGN Patients diagnosed with CHD and airway anomalies in the Pediatric Cardiac Surgery Centre of Fuwai Hospital from January 2016 to December 2020 were included in this retrospective study. Patients were divided into three groups based on different management, including the conservative group, the slide group (slide tracheoplasty), and the suspension group (suspension with external stenting). Patients' data and computed tomography measurements from medical records were reviewed. RESULTS A total of 139 patients were included in the cohort; 107 had conservative airway treatment (conservative group), 15 had slide tracheoplasty (slide group), and 17 had tracheal suspension operation (suspension group). The top three associated intracardiac anomalies were ventricular septal defect (n = 34, 24%), pulmonary artery sling (n = 22, 16%), and tetralogy of Fallot (n = 15, 11%). Compared with patients with conservative airway management (100 minutes [median], 62-152 [IQR]), the extra airway procedure prolonged cardiopulmonary bypass duration, with 202 minutes (IQR, 119-220) for the slide group and 150 minutes (IQR, 125-161) for the suspension group. Patients who underwent slide tracheoplasty required prolonged mechanical ventilation (129 minutes [median], 56-328 [IQR]). Of the total cohort, 6 in-hospital deaths, all in the conservative group, and 8 mid-to long-term deaths, with 6 in the conservative group, occurred. CONCLUSIONS Both conservative and surgical management of CHD patients with airway anomalies have promising outcomes. Extra tracheobronchial procedures, especially the slide tracheoplasty, significantly prolonged cardiopulmonary bypass duration. Based on multidisciplinary team assessment, individualized management strategies should be developed for these patients.
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Affiliation(s)
- Yuze Liu
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qiyu He
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zheng Dou
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Kai Ma
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Weinan Chen
- Information Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Dai L, Zhao L, Shen L, Pan Z, Wu C, Mo L, Wu Y. Treatment of long-segment congenital tracheal stenosis with congenital cardiovascular defects in infancy. Int J Pediatr Otorhinolaryngol 2023; 172:111691. [PMID: 37536159 DOI: 10.1016/j.ijporl.2023.111691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES This study aims to evaluate the outcomes of simultaneous repair for infants with long-segment congenital tracheal stenosis (LSCTS) with congenital cardiovascular defects (CCD). METHODS We retrospectively reviewed the clinical data of infants aged less than 1 year with LSCTS and CCD who underwent simultaneous repair at Children's Hospital of Chongqing Medical University from January 2020 to March 2023. A systematic search of PubMed, Embase, and Cochrane Library for the relevant published studies that reported the simultaneous repair of CTS and CCD in infancy was conducted in March 2023. The inverse variance method of DerSimonian-Laird (D + L) was used for estimate synthesis. RESULTS A total of thirteen infants with a mean age of 5.6 ± 3.1 months and a mean weight of 6.4 ± 0.9 Kg underwent slide tracheoplasty with modified procedures and cardiovascular operations. LSCTS was diagnosed in all thirteen patients. Nine infants were ventilator dependent, and four patients were operated on due to persistent wheezing and recurrent respiratory infections. Seven patients underwent pulmonary artery sling repair, and six underwent atrial septal defect repair. All infants were repaired utilizing cardiopulmonary bypass (CPB) support. Significant complications were recorded in three patients. In-hospital deaths were seen in one case. The median tracheal minimum diameter of hospital survivors was significantly larger than the preoperative minimum diameter (p < 0.001). The mean follow-up duration was 17.1 ± 7.1 months. There was no late mortality during the follow-up. Twelve studies were included based on our search strategy. The pooled estimate of mortality in the literature was 10.9% (95%CI, 5.3%-17.7%, I2 = 0). The pooled estimate of airway re-interventions was 28.8% (95%CI, 14.5%-43.2%, I2 = 74%). CONCLUSIONS Simultaneous repair of LSCTS and CCD in infancy is safe and effective. Slide tracheoplasty with appropriate technical modifications may be valid for LSCTS repair without significant restenosis and reinterventions.
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Affiliation(s)
- Lurun Dai
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lu Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lianju Shen
- Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lin Mo
- Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China.
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China.
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He Q, Liu Y, Dou Z, Ma K, Li S. Congenital heart diseases with airway stenosis: a predictive nomogram to risk-stratify patients without airway intervention. BMC Pediatr 2023; 23:351. [PMID: 37438689 DOI: 10.1186/s12887-023-04160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND This study focused on congenital heart disease (CHD) patients complicated with airway stenosis (AS) without airway intervention and aimed to identify the patients with potential risks. METHODS Patients diagnosed with CHD and AS were enrolled in this retrospective study. The primary outcome was defined as a postoperative mechanical ventilation duration of more than two weeks. We constructed a prediction model to predict the risk of prolonged mechanical ventilation (PMV). RESULTS A total of 185 patients diagnosed with CHD and AS in Fuwai Hospital from July 2009 to December 2022 were included in the study. Weight at CHD surgery, cardiopulmonary bypass (CPB) duration, complex CHD and comorbid tracheobronchomalacia were identified as risk factors and included in the model. The ROC curve showed a good distinguishing ability, with an AUC of 0.847 (95% CI: 0.786-0.908). According to the optimal cut-off value of the ROC curve, patients were divided into high- and low-risk groups, and the subsequent analysis showed significant differences in peri-operative characteristics and in-hospital deaths. CONCLUSIONS With the predictive model, several factors could be used to assess the risky patients with PMV. More attention should be paid to these patients by early identification and routine surveillance.
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Affiliation(s)
- Qiyu He
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Yuze Liu
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Zheng Dou
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Kai Ma
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Centre, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, China.
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Surgical management of congenital tracheal stenosis associated with complex cardiovascular anomalies. Pediatr Surg Int 2022; 38:1903-1908. [PMID: 36083305 DOI: 10.1007/s00383-022-05206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Although surgical outcomes have improved in patients with congenital tracheal stenosis (CTS), the management of such patients with complex cardiovascular anomalies (CVAs) remains a challenge. This study aimed to clarify the clinical features of this combination. METHODS Medical records of 14 patients with complex CVAs who had undergone slide tracheoplasty for CTS between May 2016 and February 2022 were retrospectively reviewed. Complex CVAs were defined as CVAs without left pulmonary artery sling and simple cardiac shunts. Data collected included age and body weight at tracheal reconstruction, preoperative respiratory support, surgery details, and mortality. RESULTS The median age and body weight at tracheal reconstruction were 3.5 (range, 1-17) months and 4.7 (range, 2.3-8.2) kg, respectively. Simultaneous repair of CTS and CVAs was performed in eight patients and staged repair in six patients. Patients who underwent simultaneous repair required preoperative respiratory support more frequently than those who underwent staged repair (8/8 [100%] vs 2/6 [33.3%]; P = 0.015). No mortality occurred. CONCLUSIONS Patients with complex CVAs often require tracheal reconstruction in early infancy. Surgical management strategy for this combination was generally decided on the basis of the severity of respiratory symptoms due to CTS.
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Sidell DR, Meister KD, de Alarcon A, Boudewyns A, Brigger M, Chun R, Fayoux P, Goudy S, Hart CK, Hewitt R, Hsu WC, Javia LR, Johnson RF, Messner AH, Moreddu E, Nicollas R, Prager JD, Rahbar R, Rickert S, Rossi ME, Russell J, Rutter M, Sandu K, Smith RJH, Soma M, Thierry B, Trozzi M, White DR, Balakrishnan K. International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Evaluation and management of congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol 2022; 161:111251. [PMID: 35988373 DOI: 10.1016/j.ijporl.2022.111251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To outline an expert-based consensus of recommendations for the diagnosis and management of pediatric patients with congenital tracheal stenosis. METHODS Expert opinions were sought from members of the International Pediatric Otolaryngology Group (IPOG) via completion of an 18-item survey utilizing an iterative Delphi method and review of the literature. RESULTS Forty-three members completed the survey providing recommendations regarding the initial history, clinical evaluation, diagnostic evaluation, temporizing measures, definitive repair, and post-repair care of children with congenital tracheal stenosis. CONCLUSION These recommendations are intended to be used to support clinical decision-making regarding the evaluation and management of children with congenital tracheal stenosis. Responses highlight the diverse management strategies and the importance of a multidisciplinary approach to care of these patients.
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Affiliation(s)
- Douglas R Sidell
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA
| | - Kara D Meister
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA
| | | | - An Boudewyns
- Antwerp University Hospital, University of Antwerp, Belgium
| | - Matthew Brigger
- Rady Children's Hospital and University of California San Diego, San DIego, CA, USA
| | - Robert Chun
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Steven Goudy
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Catherine K Hart
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Wei-Chung Hsu
- National Taiwan University Hospital and Children's Hospital, Taiwan
| | - Luv R Javia
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Eric Moreddu
- Dept of Pediatric Otolaryngology Head and Neck Surgery, Hôpital La Timone Enfants, Marseille, France
| | - Richard Nicollas
- Dept of Pediatric Otolaryngology Head and Neck Surgery, Hôpital La Timone Enfants, Marseille, France
| | - Jeremy D Prager
- Children's Hospital Colorado, University of Colorado, Denver, CO, USA
| | | | | | | | - John Russell
- Children's Health Ireland (Crumlin), Trinity College Dublin, Dublin, Ireland
| | - Michael Rutter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kishore Sandu
- Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | | | - Marlene Soma
- Sydney Children's Hospital, Edgecliff, NSW, Australia
| | - Briac Thierry
- Necker Enfants Malades Hospital - Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - David R White
- Medical University of South Carolina, Charleston, SC, USA
| | - Karthik Balakrishnan
- Stanford Children's Health Aerodigestive and Airway Reconstruction Program and Stanford University, Stanford, CA, USA.
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Zalzal HG, Behzadpour HK, Leonard J, Sinha P, Preciado DA. Systematic Review of Slide Tracheoplasty Outcomes. Ann Otol Rhinol Laryngol 2022; 132:558-565. [PMID: 35723210 DOI: 10.1177/00034894221104955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify factors predicting success in slide tracheoplasty surgery at a regional children's hospital and compare with available published literature. MEASURES Retrospective chart review comparing demographics (age, weight) and clinical (operative and hospital course, need for additional airway intervention) factors experienced with slide tracheoplasty. Findings were compared with a systematic review of published literature. RESULTS Of the 16 tracheal stenosis patients in our cohort, 13 (81.3%) presented with an additional congenital or cardiovascular anomaly. When adjusted for cardiovascular anomalies, congenital tracheal stenosis patients had a mean age of 5.2 months (range 6 days-17 months), mean weight of 5.04 kg, and average ICU and hospital length of stay of 31.5 and 36.0 days, respectively. Tracheostomy was required for 4 patients and no early deaths were recorded. Of the 391 children in the grouped cohort, mean age and weight was older at 7.67 months and larger at 5.70 kg. Length of stay in both ICU and overall hospital course was 31.6 and 43.5 days, respectively. Mortality etiology for 44 patients was reported: 17 (38.6%) cardiac-related and 28 (63.6%) late mortalities. Our overall calculated mortality risk of 1.26 (P < .05) was lower than reported ratios of 2.0+. CONCLUSION Despite the numerous institutional studies involving tracheal stenosis, mortality and surgical challenges remain high. Future studies with the inclusion of specific perioperative data can prove to further evaluate correlations between presentation characteristics and mortality.
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Affiliation(s)
- Habib G Zalzal
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
| | - Hengameh K Behzadpour
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
| | - James Leonard
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
| | - Pranava Sinha
- Department of Cardiac Surgery, Children's National Medical Center, Washington, DC, USA
| | - Diego A Preciado
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA
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Sebastian VA, Eghtesady P. ABCs of Concomitant Tracheal and Congenital Heart Surgery. World J Pediatr Congenit Heart Surg 2021; 12:737-738. [PMID: 34846968 DOI: 10.1177/21501351211050295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Pirooz Eghtesady
- 12275Washington University School of Medicine, St. Louis, MO, USA
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Surgical management strategy of slide tracheoplasty for infants with congenital tracheal stenosis. J Thorac Cardiovasc Surg 2021; 163:2218-2228. [PMID: 34872757 DOI: 10.1016/j.jtcvs.2021.10.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The study objective was to evaluate the outcomes of slide tracheoplasty in infancy and identify predictors of adverse outcomes. METHODS We retrospectively reviewed the clinical data of infants aged less than 1 year with congenital tracheal stenosis who underwent slide tracheoplasty at a single center from April 2010 to September 2020. RESULTS Of 120 infants, 71.7% (86/120) had a pulmonary artery sling and 37.5% (45/120) had simultaneous intracardiac repairs. Additionally, 52.5% (63/120) of the patients had anomalous tracheobronchial arborization, and 17.5% (21/120) had diffuse tracheal stenosis. Six airway reoperations (5%) and 6 deaths (5%) occurred, and the mortality decreased annually. Multivariate analysis revealed that a low body weight, cardiovascular anomalies, and normal tracheobronchial arborization predicted a longer intubation duration. Univariate analysis revealed that a low body weight, preoperative invasive ventilation, a long cardiopulmonary bypass time, and granulation tissue were associated with death. After surgery, 26 patients had dysphagia, 24 of whom resumed oral feeding during follow-up. Ninety-two patients underwent chest computed tomography reexamination, and the trachea diameter had increased significantly from 2.32 ± 0.72 mm to 5.46 ± 1.24 mm. Nineteen and 29 patients underwent spirometry before and after surgery, respectively, and showed improvements in ventilation function, with the ratio of time to peak tidal expiratory flow to total expiratory time and ratio of volume to peak tidal expiratory flow to total expiratory volume values significantly improved from 19.80% (interquartile range, 16.90-23.80) and 23.10% (interquartile range, 21.10-25.90) to 26.80% (interquartile range, 21.20-34.40) and 30.20% (interquartile range, 25.00-34.50), respectively (P < .05). CONCLUSIONS A tailored individual management strategy of slide tracheoplasty in infancy facilitates favorable clinical outcomes. Close postoperative follow-up and long-term functional evaluations including clinical symptoms and pulmonary function are still needed.
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Beeman A, Ramaswamy M, Chippington S, Wallis C, Hayden M, Hewitt R, Muthialu N. Risk Stratification of Slide Tracheoplasty for Pediatric Airway Stenosis. Ann Thorac Surg 2021; 113:1299-1306. [PMID: 33864756 DOI: 10.1016/j.athoracsur.2021.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 04/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Slide tracheoplasty (STP) is the procedure of choice for treatment of long segmental congenital tracheal stenosis (LSCTS). Few studies predict factors leading to reintervention or mortality after STP. We analyzed a pediatric population to identify such factors and compared the outcome between 2 eras (1995-2012 and 2013-2017). METHODS We analyzed 150 consecutive children who underwent STP from February 1995 to December 2017 in our hospital. RESULTS Median age and weight were 6.9 months and 6.1 kg. Average tracheal diameter of LSCTS was 2.3 mm. Tracheal stenosis extended into bronchus in 36 patients and distal malacia in 38. Median follow-up was 67 months; mortality was 12.7%. Balloon dilatation was required in 81 patients (54%), stents in 29 (19%), and reoperation in 4 (3%). The presence of malacia, preoperative extracorporeal membrane oxygenation, congenital anomalies, and single lung anatomy increased the risk for reintervention. Cox regression analysis revealed preoperative ventilation to be an independent factor predicting reintervention and single lung tracheal anatomy for mortality. In the current era (after 2013), survival improved from 88% to 97% and stent requirement was reduced from 25% to 11%. CONCLUSIONS Slide tracheoplasty can be applied to various airway configurations seen in LSCTS. The requirement for reintervention such as balloon dilatation and stenting is high in the group requiring preoperative ventilation. Mortality is highest in the single lung anatomy group. Centralization of care allowed us to develop the multidisciplinary team expertise to manage this and other rare airway conditions with acceptable outcomes.
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Affiliation(s)
- Arun Beeman
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Madhavan Ramaswamy
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Samantha Chippington
- Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Collin Wallis
- Department of Respiratory Medicine, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mark Hayden
- Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Richard Hewitt
- ENT, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom.
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Miller JR, Eghtesady P. Commentary: Airway anomalies and congenital heart defects, a dangerous combination. J Thorac Cardiovasc Surg 2020; 161:1122-1123. [PMID: 33341276 DOI: 10.1016/j.jtcvs.2020.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jacob R Miller
- Washington University in St Louis School of Medicine/St Louis Children's Hospital, St. Louis, Mo
| | - Pirooz Eghtesady
- Washington University in St Louis School of Medicine/St Louis Children's Hospital, St. Louis, Mo.
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