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Harrison C, Harrison J, Fricke TA, Konstantinov IE. Achieving normal pulmonary function following tracheoplasty in infancy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae152. [PMID: 39222638 PMCID: PMC11387765 DOI: 10.1093/icvts/ivae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/04/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024]
Abstract
Infant long-segment congenital tracheal stenosis (LTS) is rare and presents a challenging clinical scenario. We describe the management of a child who required extracorporeal membrane oxygenation following a respiratory arrest and underwent slide tracheoplasty in infancy for severe LTS and required repeated bronchoscopic reinterventions for recurrent tracheal granulations. At 9 years of age, the child has normal pulmonary function testing and a normal exercise tolerance.
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Affiliation(s)
- Ciara Harrison
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Jo Harrison
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Tyson A Fricke
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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2
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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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Karkhanis T, Byju AG, Morales DL, Zafar F, Haridas B. Composite Biosynthetic Graft for Repair of Long-Segment Tracheal Stenosis: A Pilot In Vivo and In Vitro Feasibility Study. ASAIO J 2024; 70:527-534. [PMID: 38170278 PMCID: PMC11139240 DOI: 10.1097/mat.0000000000002130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Pediatric patients who undergo surgery for long-segment congenital tracheal stenosis (LSCTS) have suboptimal outcomes and postsurgical complications. To address this, we propose a biosynthetic graft comprising (1) a porcine small intestinal submucosa extracellular matrix (SIS-ECM) patch for tracheal repair, and (2) a resorbable polymeric exostent for biomechanical support. The SIS-ECM patch was evaluated in vivo in an ovine trachea model over an 8 month period. Concurrently, the biosynthetic graft was evaluated in a benchtop lamb trachea model for biomechanical stability. In vivo results show that SIS-ECM performs better than bovine pericardium (control) by preventing granulation tissue/restenosis, restoring tracheal architecture, blood vessels, matrix components, pseudostratified columnar and stratified epithelium, ciliary structures, mucin production, and goblet cells. In vitro tests show that the biosynthetic graft can provide the desired axial and flexural stability, and biomechanical function approaching that of native trachea. These results encourage future studies to evaluate safety and efficacy, including biomechanics and collapse risk, biodegradation, and in vivo response enabling a stable long-term tracheal repair option for pediatric patients with LSCTS and other tracheal defects.
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Affiliation(s)
- Teja Karkhanis
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | - Achu G. Byju
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | | | - Farhan Zafar
- Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Balakrishna Haridas
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
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Kao DD, Fuu-Kou Y, Wang CS, Lehenbauer D, Zak S, Benscoter D, Morales DL, de Alarcon A, Rutter MJ. Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies. Laryngoscope 2023; 133:3334-3340. [PMID: 37159210 DOI: 10.1002/lary.30737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Bronchial anomalies are rare but challenging conditions to treat in children, encompassing a variety of structural abnormalities that could compromise airway patency. This includes complete rings, absent cartilage, traumatic avulsions, bronchoesophageal fistulas, and cartilaginous sleeves. The objective of this study is to describe the characteristics and outcomes of a series of pediatric cases of bronchial anomalies that were treated by slide tracheobronchoplasty. METHODS This is a single-institution retrospective case series of pediatric patients with bronchial anomalies who underwent surgical treatment between February 2004 and April 2020. Data extracted from electronic medical records included patient demographics, comorbidities, and surgical outcomes. RESULTS There were a total of 29 patients included in the study, of which 14 had complete bronchial rings, 8 had absent bronchial rings, 4 had traumatic bronchial avulsions, 2 had bronchoesophageal fistulas, and one had a cartilaginous sleeve. Median follow-up time was 13 months (with a range of 0.5-213 months). The overall mortality rate was 17.2% (5 patients), all of whom had complete bronchial rings. Patients with complete bronchial rings also had a higher rate of not only cardiac (85.7%) and pulmonary comorbidities (85.7%) but also secondary airway lesions (78.6%). CONCLUSION This is the largest series to date describing surgical treatment for bronchial anomalies. Complete bronchial rings were the most common anomaly treated, followed by absent rings and trauma. Surgical treatment can be successful but mortality rates are higher in patients with complete bronchial rings, possibly due to higher rates of pulmonary and cardiac comorbidities. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3334-3340, 2023.
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Affiliation(s)
- Derek D Kao
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yann Fuu-Kou
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cynthia S Wang
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Lehenbauer
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara Zak
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Dan Benscoter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David Ls Morales
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Schweiger T, Evermann M, Roesner I, Denk-Linnert DM, Klepetko W, Hoetzenecker K. [Paediatric Airway Surgery - Indications and Techniques]. Laryngorhinootologie 2023; 102:652-657. [PMID: 37216962 DOI: 10.1055/a-1985-1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Even in specialised centres, surgical procedures on the airway are only rarely performed in paediatric patients. Moreover, knowledge of various specific anatomical characteristics, diseases and surgical techniques is a prerequisite to treat these patients. Most commonly, sequelae of long-term intubation or tracheostomy in multimorbid patients necessitate surgical repair. Moreover, congenital malformations of the airways might require surgical interventions. However, these are commonly associated with other organ malformations, which adds further complexity to the treatment concept. Thus, cooperation within an interdisciplinary team is absolutely necessary to treat these patients. However, good postoperative outcomes after paediatric airway surgery can be achieved in experienced centres with an appropriate infrastructure. Specifically, this means long-term tracheostomy-free survival with preserved laryngeal functions in most of the patients. This review provides a summary of common indications and surgical techniques in paediatric airway surgery.
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Affiliation(s)
- Thomas Schweiger
- Department of Thoracic Surgery, Medizinische Universität Wien, Wien, Österreich
| | - Matthias Evermann
- Department of Thoracic Surgery, Medizinische Universität Wien, Wien, Österreich
| | - Imme Roesner
- Department of Phoniatrics, Medizinische Universität Wien, Wien, Österreich
| | | | - Walter Klepetko
- Department of Thoracic Surgery, Medizinische Universität Wien, Wien, Österreich
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medizinische Universität Wien, Wien, Österreich
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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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Schweiger T, Evermann M, Roesner I, Denk-Linnert DM, Klepetko W, Hoetzenecker K. Pädiatrische Atemwegschirurgie: Indikationen und
Techniken. Zentralbl Chir 2022; 147:299-304. [DOI: 10.1055/a-1727-6196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungIn der pädiatrischen Atemwegschirurgie sind zahlreiche anatomische
Besonderheiten, spezifische Krankheitsbilder sowie spezielle Operationstechniken
zu beachten. Auch an spezialisierten Zentren sind diese Eingriffe bei
pädiatrischen Patienten eher selten. Ätiologisch handelt es sich meist um
erworbene Stenosen als Folge von Frühgeburtlichkeit, Langzeitintubation oder
-tracheotomie, welche typischerweise in Kindern mit zahlreichen Komorbiditäten
auftreten. Kongenitale Fehlbildungen der Atemwege gehen häufig mit weiteren
Malformationen einher, welche die erfolgreiche Behandlung zusätzlich erschweren.
Voraussetzung zur Behandlung dieser Kinder sollte daher ein multidisziplinäres
Team sein. An erfahrenen Zentren mit entsprechender Infrastruktur kann die
chirurgische Behandlung dieser Kinder mit sehr guten Ergebnissen durchgeführt
werden. So wird bei den meisten Patienten nach chirurgischer Behandlung eine
sehr gute Lebensqualität ohne Notwendigkeit einer Langzeittracheostomie
erreicht. Diese Übersichtsarbeit fasst die wichtigsten Indikationen, sowie die
häufigsten Operationstechniken in der pädiatrischen Atemwegschirurgie
zusammen.
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Affiliation(s)
- Thomas Schweiger
- Department of Thoracic Surgery, Medizinische Universität
Wien, Wien, Österreich
| | - Matthias Evermann
- Department of Thoracic Surgery, Medizinische Universität
Wien, Wien, Österreich
| | - Imme Roesner
- Department of Phoniatrics, Medizinische Universität
Wien, Wien, Österreich
| | | | - Walter Klepetko
- Department of Thoracic Surgery, Medizinische Universität
Wien, Wien, Österreich
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medizinische Universität
Wien, Wien, Österreich
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Chikwe J. Editor's Choice: Critical Times for Coronary Revascularization Guidelines. Ann Thorac Surg 2022; 113:1061-1064. [PMID: 35346446 DOI: 10.1016/j.athoracsur.2022.02.018] [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: 02/21/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Backer CL. Regionalization Equals Excellence in Pediatric Tracheal Surgery. Ann Thorac Surg 2021; 113:1306. [PMID: 34023238 DOI: 10.1016/j.athoracsur.2021.04.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Carl L Backer
- Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, 800 Rose Street, C-259, Lexington, KY 40536-0293.
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