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Incidence and risk factor of vocal cord paralysis following slide tracheoplasty for congenital tracheal stenosis: a retrospective observational study. Cardiol Young 2022; 32:579-583. [PMID: 34247683 DOI: 10.1017/s1047951121002663] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Slide tracheoplasty for congenital tracheal stenosis (CTS) has been shown to improve post-operative outcomes, but the incidence and risk factors of vocal cord paralysis (VCP) following slide tracheoplasty remain unclear. This study aimed to review our experience of slide tracheoplasty for CTS with a focus on post-operative VCP. METHODS Twenty-eight patients, who underwent tracheal reconstruction with or without cardiovascular repair at Kobe Children's Hospital between June, 2016 and March, 2020 were enrolled in this retrospective observational study. They were divided into two groups based on the presence of a pulmonary artery sling (PA sling). Perioperative variables were compared between the two groups. RESULTS Twenty-one of the 28 patients underwent concomitant repair for associated cardiovascular anomalies, including 15 patients with PA sling. The overall incidence of VCP following slide tracheoplasty was 28.6%. The incidences of VCP were 46.7% in patients with CTS and PA sling, which were 14.3% in CTS patients without cardiovascular anomalies. The only risk factor associated with VCP following slide tracheoplasty was a concomitant repair for PA sling. Post-operatively, the duration of nasogastric tube feeding in patients with VCP was significantly longer than that in patients without VCP. CONCLUSIONS The incidence of VCP following slide tracheoplasty for CTS was high, especially in concomitant repair cases for PA sling. Routine screening and evaluation of VCP soon after post-operative extubation is required for its appropriate management.
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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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Kou YF, Redmann A, Tabangin ME, Wilcox L, Miller CK, Smith M, Myer C, Hart CK, Rutter MJ, de Alarcon A. Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children. Laryngoscope 2021; 131:2798-2804. [PMID: 34032289 DOI: 10.1002/lary.29608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate swallowing and airway outcomes following laryngotracheoplasty with posterior grafting (LTP PCCG). METHODS Retrospective review of pediatric patients undergoing LTP PCCG from 2016 to 2019 at a tertiary care pediatric hospital. We included demographics, indications, approach, and revision status. We evaluated preoperative and postoperative instrumental and functional swallow evaluations, and we also gathered information on airway outcomes. RESULTS Thirty-one patients were included in the study. Median (interquartile range [IQR]) age was 4.0 (2.0, 7.0) years old. Primary indication for surgery was bilateral vocal cord immobility (BVCI) in 11 (35.5%) and posterior glottic stenosis (PGS) in 20 (64.5%). Mean (standard deviation) length of follow-up was 11.0 (8.3) months. Twelve patients had gastrostomy tubes (GT) before surgery, and no patients required placement of GT after surgery. Of the remaining 19 patients, 6 required nasogastric feeding for >4 weeks (average length 1.8 months, longest 3.5 months). At last follow-up, 25 (80.6%) patients were primarily orally fed. Eighteen patients had tracheotomies prior to surgery. No patients without a tracheostomy required placement of tracheostomy before or after surgery and only 1 patient had a tracheostomy at last follow-up. Average time to decannulation was 3.7 months, with surgery-specific success of 87.1% and overall success of 96.8%. Four (12.9%) patients required a major intervention to achieve decannulation. CONCLUSION LTP PCCG is an effective surgical technique to address PGS and BVCI with high decannulation rates. It may cause temporary swallowing dysfunction, but in this series a majority of children were orally fed at last follow-up. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Yann-Fuu Kou
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Andrew Redmann
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Lyndy Wilcox
- Division of Pediatric Otolaryngology, Vanderbilt University Medical center, Nashville, Tennessee, U.S.A
| | - Claire K Miller
- Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Matthew Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Charles Myer
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
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Muthialu N, Ramaswamy M, Beeman A, Yeh YT. Management of Tracheal Diseases in Children. Front Pediatr 2020; 8:297. [PMID: 32656164 PMCID: PMC7325888 DOI: 10.3389/fped.2020.00297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022] Open
Abstract
Tracheal pathology in children are primarily congenital. They can be considered primary or de novo, when this is seen as an inherent defect within the cartilages of the tracheal segment. While segmental cartilage defects are very rare, there are often occasions when one or more cartilages can be considered missing from the length of trachea, contributing to airway abnormality. Secondary tracheal pathologies can often be seen in relation to disorders affecting nearby vascular elements or thoracic cage in general. In general, the pathological entity of tracheal disorders can be classified into either tracheomalacia or tracheal stenosis.
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Affiliation(s)
- Nagarajan Muthialu
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Madhavan Ramaswamy
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Arun Beeman
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Yi-Ting Yeh
- Tracheal Team, Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
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Yong MS, Zhu MZL, Bell D, Alphonso N, Brink J, d'Udekem Y, Konstantinov IE. Long-term outcomes of surgery for pulmonary artery sling in children. Eur J Cardiothorac Surg 2019; 56:5305059. [PMID: 30715328 DOI: 10.1093/ejcts/ezz012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/06/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pulmonary artery (PA) sling is a rare vascular anomaly often associated with congenital tracheal stenosis. We describe the long-term outcomes with repair of this condition. METHODS A retrospective study was conducted at 2 institutions. From 1984 to 2018, 33 patients with PA sling underwent repair. RESULTS The median age at the time of surgery was 5.9 months (quartile 1-3: 2.5-12 months). Concomitant tracheal surgery was required in 21 patients (64%) where slide tracheoplasty was used in 11 patients (52%). There were no early deaths in patients who did not require tracheal surgery (n = 12). Operative mortality was 22% (2 of 9 patients) between 1984 and 1993, 11% (1 of 9 patients) between 1994 and 2003 and 6.7% (1 of 15 patients) between 2004 and 2018. The 15-year probability of survival for patients who had PA sling repair alone was 100%, and for patients who required PA sling and tracheal repair was 76 ± 10% (95% confidence interval 51-89%) (P = 0.08). The mean follow-up for survivors was 14 ± 9.8 years (3 months-33 years). All survivors were in the New York Heart Association functional class I/II at the last follow-up. Spirometry performed at a median age of 10.4 years after PA sling and tracheal surgery demonstrated obstructive lung defects with median forced expiratory volume in 1 s of 1.0 l (48% predicted), forced vital capacity of 1.5 l (74% predicted) and forced expiratory volume in 1 s/forced vital capacity of 0.69 (78% predicted). CONCLUSIONS Early mortality after PA sling repair is determined by the need for tracheal surgery. Though late survival was excellent, and the majority of survivors remained asymptomatic, long-term respiratory assessment and follow-up is warranted for these patients.
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Affiliation(s)
- Matthew S Yong
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael Z L Zhu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Douglas Bell
- Department of Cardiac Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - Nelson Alphonso
- Department of Cardiac Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - Johann Brink
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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