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Nguyen KT, Van Nguyen AT, Tran VQ, Nguyen YT, Le CT, Van Dang T, Jun TG, Nguyen TLT. Impact of preoperative respiratory distress on outcomes of slide tracheoplasty. Eur J Cardiothorac Surg 2024; 65:ezae227. [PMID: 38830041 DOI: 10.1093/ejcts/ezae227] [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: 01/10/2024] [Revised: 04/29/2024] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVES Children with congenital tracheal stenosis born in the developing world face a high risk of mortality due to limited access to proper treatment. Patients who required preoperative respiratory support were suspected to have poor survival after slide tracheoplasty; however, this was not clearly demonstrated in the previous studies. This study aims to investigate the impact of preoperative respiratory conditions on outcomes of slide tracheoplasty. METHODS From 2016 to 2022, children who underwent slide tracheoplasty were retrospectively reviewed. Patients with respiratory distress requiring emergency operations (group A) were compared with patients in stable condition who were scheduled for surgery (group B). RESULTS Perioperative results revealed that group A (n = 43) had a longer bypass time (P < 0.001), operation time (P = 0.01), postoperative ventilation time (P < 0.001) and length of intensive care unit stay (P = 0.00125) than group B (n = 60). The early mortality rate was 7.8%, and the actuarial 5-year survival rate was 85.3%. The cumulative incidence test revealed that group A was highly significant for overall mortality [sudistribution (SHR) 4.5; 95% confidence interval (CI) 1.23-16.4; P = 0.023]. Risk factors for overall mortality were prolonged postoperative ventilation time (hazard ratio 3.86; 95% CI 1.20-12.48; P = 0.024), bronchial stenosis (hazard ratio 5.77; 95% CI 1.72-19.31; P = 0.004), and preoperative tracheal mucositis (hazard ratio 5.67; 95% CI 1.51-21.31; P = 0.01). Four patients needed reintervention during a follow-up of 28.4 months (interquartile range 15.3-47.3). CONCLUSIONS Preoperative respiratory distress negatively affected the outcomes of patients who required slide tracheoplasty. Therefore, early detection of congenital tracheal stenosis and aggressive slide tracheoplasty are crucial and obligatory to enhance long-term survival in this lethal congenital airway disease.
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Affiliation(s)
| | - Anh Thi Van Nguyen
- Department of Cardiology, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Vinh Quang Tran
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Yen Thi Nguyen
- Department of Pediatrics, Hanoi Medical University, Hanoi, Vietnam
| | - Chuong Thanh Le
- Department of Pneumology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Thuc Van Dang
- Department of Intensive Care Unit, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea
| | - Truong Ly Thinh Nguyen
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
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Qi C, Cheng L, Huang C. Artificial Trachea from Microtissue Engineering and Three-Dimensional Printing for Tracheal Personalized Repair. Tissue Eng Part A 2024; 30:393-403. [PMID: 38265006 DOI: 10.1089/ten.tea.2023.0171] [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] [Indexed: 01/25/2024] Open
Abstract
Millions of people suffer from tracheal defect worldwide each year, while autograft and allograft cannot meet existing treatment needs. Tissue-engineered trachea substitutes represent a promising treatment for tracheal defect, while lack of precisely personalized treatment abilities. Therefore, development of an artificial trachea that can be used for personalized transplantation is highly desired. In this study, we report the design and fabrication of an artificial trachea based on sericin microsphere (SM) by microtissue engineering technology and three-dimensional (3D) printing for personalized repair of tracheal defect. The SM possessed natural cell adhesion and promoting cell proliferation ability. Then, the microtissue was fabricated by coincubation of SM with chondrocytes and tracheal epithelial cells. This microtissue displayed good cytocompatibility and could support seed cell adhesion and proliferation. After that, this microtissue was individually assembled to form an artificial trachea by 3D printing. Notably, artificial trachea had an encouraging complete cartilaginous and epithelial structure after transplantation. Furthermore, the artificial trachea molecularly resembled native trachea as evidenced by similar expression of trachea-critical genes. Altogether, the work demonstrates the effectiveness of microtissue engineering and 3D printing for individual construction of artificial trachea, providing a promising approach for personalized treatment of tracheal defect.
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Affiliation(s)
- Chao Qi
- Department of Pharmacy, Wuhan No.1 Hospital, Wuhan, China
| | - Lu Cheng
- Department of Pharmacy, Wuhan No.1 Hospital, Wuhan, China
| | - Chuanqi Huang
- Department of Pharmacy, Wuhan No.1 Hospital, Wuhan, China
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Yoshida S, Matsumoto I, Saito D, Tanaka Y, Takemura H, Oi A. Partial Tracheal Defects Closure using Glutaraldehyde-Treated Autologous Pericardium. Thorac Cardiovasc Surg 2023; 71:490-496. [PMID: 36216333 PMCID: PMC10480013 DOI: 10.1055/s-0042-1757301] [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: 04/11/2022] [Accepted: 08/25/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The usefulness of autologous pericardium treated with glutaraldehyde (GA) for tracheal defect closure is unknown. This study preliminarily evaluated whether a GA-treated autologous pericardial graft can effectively close tracheal defects in a beagle model. METHODS Defects of 10 mm × 10 mm were created on the trachea of 10 beagles and divided into a GA-treated group (n = 5), with tracheal reconstruction using GA-treated pericardium, and control group (n = 5), using fresh pericardium. Repair sites were evaluated through bronchoscopy and histology. Blood flows on graft were measured using laser Doppler technique on postoperative days (PODs) 0, 4, 7, 14, 28, and 56. Repair sites were histologically evaluated on POD 56. In addition, GA-treated pericardia of three other beagles were histologically evaluated 12 months postoperatively, for long-term follow-up. RESULTS All animals survived; none developed anastomotic insufficiency. The mean suturing time and frequency of additional suture were significantly shorter and lower in the GA-treated group than in the control group (p = 0.002, 0.004). All animals in the control group exhibited graft contraction, whereas the GA-treated group healed with most graft residual and reepithelialization in the bronchoscopic and histological findings (p = 0.01, 0.004). Further, all long-term GA-treated pericardia of three beagles were confirmed as residual grafts with reepithelialization, without contraction, at 12 months postoperatively. Blood flows on graft using laser Doppler technique in the GA-treated group were detected at POD 14 or thereafter. CONCLUSION GA-treated pericardium was easier to handle and provided favorable scaffolding, without graft contraction, compared with the nontreated pericardium at short- and long-term follow-up.
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Affiliation(s)
- Shuhei Yoshida
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Isao Matsumoto
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Daisuke Saito
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Yusuke Tanaka
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Kanazawa University, Kanazawa, Japan
| | - Akishi Oi
- Department of Molecular and Cellular Pathology, Kanazawa University, Kanazawa, Japan
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Ren J, Xu Y, Zhiyi G, Ren T, Ren J, Wang K, Luo Y, Zhu M, Tan Q. Reconstruction of the trachea and carina: Surgical reconstruction, autologous tissue transplantation, allograft transplantation, and bioengineering. Thorac Cancer 2022; 13:284-295. [PMID: 35023311 PMCID: PMC8807246 DOI: 10.1111/1759-7714.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022] Open
Abstract
There have been significant advancements in medical techniques in the present epoch, with the emergence of some novel operative substitutes. However, the treatment of tracheal defects still faces tremendous challenges and there is, as yet, no consensus on tracheal and carinal reconstruction. In addition, surgical outcomes vary in different individuals, which results in an ambiguous future for tracheal surgery. Although transplantation was once an effective and promising method, it is limited by a shortage of donors and immune rejection. The development of bioengineering has provided an alternative for the treatment of tracheal defects, but this discipline is full of ethical controversy and hindered by limited cognition in this area. Meanwhile, progression of this technique is blocked by a deficiency in ideal materials. The trachea together with the carina is still the last unpaired organ in thoracic surgery and propososal of a favorable scheme to remove this dilemma is urgently required. In this review, four main tracheal reconstruction methods, especially surgical techniques, are evaluated, and a thorough interpretation conducted.
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Affiliation(s)
- Jianghao Ren
- Department of Thoracic SurgeryShanghai Chest Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Yuanyuan Xu
- Department of Thoracic SurgeryShanghai Chest Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Guo Zhiyi
- Department of Thoracic SurgeryShanghai Chest Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Ting Ren
- Department of Thoracic SurgeryShanghai Chest Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Jiangbin Ren
- Huai'an First People's Hospital, Nanjing Medical UniversityHuai'anJiangsuChina
| | - Kan Wang
- The 4th Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Yiqing Luo
- Department of Thoracic SurgeryShanghai Chest Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Mingyang Zhu
- Department of Thoracic SurgeryShanghai Chest Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Qiang Tan
- Department of Thoracic SurgeryShanghai Chest Hospital, Shanghai Jiaotong UniversityShanghaiChina
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Sengupta A, Murthy RA. Congenital tracheal stenosis & associated cardiac anomalies: operative management & techniques. J Thorac Dis 2020; 12:1184-1193. [PMID: 32274199 PMCID: PMC7139091 DOI: 10.21037/jtd.2019.10.42] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital tracheal stenosis can lead to symptomatic airway obstruction in children and often mandates surgical correction. Over the past half-century, numerous tracheal reconstruction techniques have been developed, including tracheal resection with end-to-end anastomosis (for short-segment complete tracheal stenosis), patch tracheoplasty, slide tracheoplasty, and homograft and autograft augmentation repairs. However, operative management of congenital tracheal stenosis is often complicated by the presence of congenital heart disease, the most common of which is pulmonary artery sling. When present concomitantly, combined repair of both defects is feasible and is currently the preferred approach. Questions have been raised about the optimal timing and sequence of surgery, and some have advocated staged repair for patients with complex associated cardiac lesions. However, evidence from the past two decades suggests that concomitant repair can be performed with excellent results. The current standard of care involves the use of cardiopulmonary bypass to simultaneously repair the tracheal defect using slide tracheoplasty and all associated cardiac anomalies. Advances in operative techniques and extracorporeal circulation, progressive understanding of the pathological basis of combined congenital tracheal and cardiac disease, and a multidisciplinary approach to patient care have all contributed to the successful outcomes seen in the modern era. This article describes the combined surgical correction of tracheal stenosis and double-outlet right ventricle-tetralogy of Fallot type in an infant, provides a detailed step-by-step description for performing a slide tracheoplasty along with various other less favored tracheoplasty techniques, and reviews the current literature discussing such combined repairs.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raghav A Murthy
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
RATIONALE Primary end-to-end anastomosis is common in adult trachea resection. Nevertheless, considering that the utilization of grafts is still essential for restoring defect in long-segment tracheal resection surgery, long-segment tracheal resection and reconstruction still remain challenging. Herein we present a novel case in which we resected a large tracheal mass and reconstructed the long-segment defect through using a thyroid-pericardium flap, which has not been reported yet. PATIENT CONCERNS A 35-year old male patient was admitted due to 'Repeated dry cough for 2 years, shortness of breath after activities for 1 month'. Patient had no other obvious symptoms. DIAGNOSES CT revealed that a large neoplasm was located in the cervical trachea and the pedicle was in the tracheal membrane, with total length of approximately 6 cm. Positron emission tomography computed tomography demonstrated an abnormally elevated levels of glucose metabolism in the upper part of the posterior tracheal wall. Therefore, this lesion was primarily considered as a malignancy. INTERVENTIONS The patient was performed by a primary resection of long-segment tracheal mass followed by thyroid-pericardium composite tissue flap for reconstruction. OUTCOME The operation was successful, without hydrops or pneumatosis in the mediastinum. One week postoperatively, CT showed that there was no pneumomediastinum and mediastinal abscess. Three weeks postoperatively, fiber bronchoscope showed the flap with normal color and the unobstructed tracheal cavity. The patient healed without complication. LESSONS The thyroid-pericardium flap is a convenient, secure, and effective material for long-segment trachea mass resection and reconstruction.
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Johnson RF, Eaviz N, Truelson JM, Day AT. Perioperative outcomes after tracheoplasty: A NSQIP analysis 2014-2016. Laryngoscope 2019; 130:1514-1519. [PMID: 31498450 DOI: 10.1002/lary.28280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Tracheoplasty or tracheal resection and are essential components of the care of patients with severe tracheal stenosis. We aimed to study the perioperative outcomes of patients after tracheoplasty or resection using a national surgical registry. METHODS We analyzed the 2014 to 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant use file for patients who underwent tracheal resection or tracheoplasty (CPT codes 31750, 31760, 31780, and 31781). We analyzed the perioperative outcomes including length of stay (LOS), dehiscence, unplanned reintubations, unplanned surgeries, and 30-day readmission rates. A random 4:1 sample of non-tracheoplasty patients served as the control group. RESULTS From 2014 to 2016, 126 patients underwent tracheoplasty. The median age was 56 years (IQR = 45-63). There were 93 (74%) females, 88 (70%) white, and 3.2% (4/126) Hispanic. The median LOS was 7 days (IQR = 5-10 days). Of these, 4.8% (6/126) developed wound infections and 3/126 (2.4%) developed wound dehiscence. Five out of 126 required unplanned reintubation (4.0%) and 16/126 (13%) had an unplanned reoperation. The 30-day unplanned readmission rate was 16% (20/126). The wound infection, unplanned intubations, and readmission rates were significantly higher (P < .005) than the control group. CONCLUSIONS The 30-day perioperative outcomes of adult patients undergoing tracheoplasty showed that adverse events are common, but severe adverse events such as death are rare. Continued research into risk mitigation among these patients is warranted. LEVEL OF EVIDENCE NA Laryngoscope, 130:1514-1519, 2020.
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Affiliation(s)
- Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Nathan Eaviz
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - John M Truelson
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
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Long-term outcomes of patch tracheoplasty using collagenous tissue membranes (biosheets) produced by in-body tissue architecture in a beagle model. Surg Today 2019; 49:958-964. [PMID: 31098758 DOI: 10.1007/s00595-019-01818-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/18/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Although various artificial tracheas have been developed, none have proven satisfactory for clinical use. In-body tissue architecture (IBTA) has enabled us to produce collagenous tissues with a wide range of shapes and sizes to meet the needs of individual recipients. In the present study, we investigated the long-term outcomes of patch tracheoplasty using an IBTA-induced collagenous tissue membrane ("biosheet") in a beagle model. METHODS Nine adult female beagles were used. Biosheets were prepared by embedding cylindrical molds assembled with a silicone rod and a slitting pipe into dorsal subcutaneous pouches for 2 months. The sheets were then implanted by patch tracheoplasty. An endoscopic evaluation was performed after 1, 3, or 12 months. The implanted biosheets were harvested for a histological evaluation at the same time points. RESULTS All animals survived the study. At 1 month after tracheoplasty, the anastomotic parts and internal surface of the biosheets were smooth with ciliated columnar epithelium, which regenerated into the internal surface of the biosheet. The chronological spread of chondrocytes into the biosheet was observed at 3 and 12 months. CONCLUSIONS Biosheets showed excellent performance as a scaffold for trachea regeneration with complete luminal epithelium and partial chondrocytes in a 1-year beagle implantation model of patch tracheoplasty.
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Stewart AJ, Butler CR, Muthialu N, Sell D, Marchant J, Hewitt RJD, Elliott MJ. Swallowing outcomes in children after slide tracheoplasty. Int J Pediatr Otorhinolaryngol 2018; 108:85-90. [PMID: 29605373 DOI: 10.1016/j.ijporl.2018.02.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Slide tracheoplasty is now considered gold standard treatment for long segment congenital tracheal stenosis. Outcomes are typically focused upon airway patency. Dysphagia is often reported in children undergoing cardiothoracic surgery, but not specifically after slide tracheoplasty. This study was carried out to describe the nature and prevalence of dysphagia following slide tracheoplasty for long segment congenital tracheal stenosis. METHODS Retrospective case note review was conducted on a series of patients who underwent swallow evaluation following slide tracheoplasty between 2006 and 2014. A clinical swallow assessment was carried out by a Speech and Language Therapist with videofluoroscopic evaluation of swallowing where indicated. Logistic regression assessed the impact of gender, feeding history, weight, tracheal diameter, stenting and co-morbidities on the likelihood of having post-operative dysphagia. RESULTS 43 out of 83 slide tracheoplasty patients underwent swallow evaluation. Dysphagia was identified in 30 (70%) of 43 patients. Videofluoroscopy was undertaken in 22 of these patients. All patients who had a videofluoroscopy presented with altered swallow physiology. Aspiration risk was confirmed in 15 patients with frank aspiration seen in 9. Pre-operative history of dysphagia was present in 9 patients. There were two cases of vocal fold palsy. The presence of a stent was the strongest predictor of post-operative dysphagia with an odds ratio of 10.6 (95% CI 1.2-92.8). CONCLUSIONS This study documents a high prevalence of post-operative dysphagia in a pediatric population following slide tracheoplasty. In most cases there was no history suggestive of dysphagia pre-operatively. Swallowing needs to be assessed after slide tracheoplasty and longitudinal studies are required.
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Affiliation(s)
- Alexandra J Stewart
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
| | - Colin R Butler
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Nagarajan Muthialu
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Debbie Sell
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Joseph Marchant
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Richard J D Hewitt
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Martin J Elliott
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
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Bhora FY, Lewis EE, Rehmani SS, Ayub A, Raad W, Al-Ayoubi AM, Lebovics RS. Circumferential Three-Dimensional-Printed Tracheal Grafts: Research Model Feasibility and Early Results. Ann Thorac Surg 2017; 104:958-963. [PMID: 28619543 DOI: 10.1016/j.athoracsur.2017.03.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/14/2017] [Accepted: 03/27/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Methods for tracheal graft research have presented persistent challenges to investigators, and three-dimensional (3D)-printed biosynthetic grafts offer one potential development platform. We aimed to develop an efficient research platform for customizable circumferential 3D-printed tracheal grafts and evaluate feasibility and early structural integrity with a large-animal model. METHODS Virtual 3D models of porcine subject tracheas were generated using preoperative computed tomography scans. Two designs were used to test graft customizability and the limits of the construction process. Designs I and II used 270-degree and 360-degree external polycaprolactone scaffolds, respectively, both encompassing a circumferential extracellular matrix collagen layer. The polycaprolactone scaffolds were made in a fused-deposition modeling 3D printer and customized to the recipient's anatomy. Design I was implanted in 3 pigs and design II in 2 pigs, replacing 4-ring tracheal segments. Data collected included details of graft construction, clinical outcomes, bronchoscopy, and gross and histologic examination. RESULTS The 3D-printed biosynthetic grafts were produced with high fidelity to the native organ. The fabrication process took 36 hours. Grafts were implanted without immediate complication. Bronchoscopy immediately postoperatively and at 1 week demonstrated patent grafts and appropriate healing. All animals lived beyond a predetermined 1-week survival period. Bronchoscopy at 2 weeks showed significant paraanastomotic granulation tissue, which, along with partial paraanastomotic epithelialization, was confirmed on pathology. Overall survival was 17 to 34 days. CONCLUSIONS We propose a rapid, reproducible, resource efficient method to develop various anatomically precise grafts. Further graft refinement and strategies for granulation tissue management are needed to improve outcomes.
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Affiliation(s)
- Faiz Y Bhora
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Erik E Lewis
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sadiq S Rehmani
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adil Ayub
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wissam Raad
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adnan M Al-Ayoubi
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert S Lebovics
- Department of Otolaryngology, Mount Sinai West, Mount Sinai Health System, New York, New York
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Virk JS, Zhang H, Nouraei R, Sandhu G. Prosthetic reconstruction of the trachea: A historical perspective. World J Clin Cases 2017; 5:128-133. [PMID: 28470004 PMCID: PMC5395980 DOI: 10.12998/wjcc.v5.i4.128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/17/2017] [Accepted: 02/20/2017] [Indexed: 02/05/2023] Open
Abstract
This review discusses the history of tracheal reconstruction; from early work to future challenges. The focus is primarily on prosthetic tracheal reconstruction in the form of intraluminal stents, patch repairs, circumferential repairs and replacement of the trachea. A historical perspective of materials used such as foreign materials, autografts, allografts, xenografts and techniques, along with their advantages and disadvantages, is provided.
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12
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Den Hondt M, Vranckx JJ. Reconstruction of defects of the trachea. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:24. [PMID: 28070690 DOI: 10.1007/s10856-016-5835-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/16/2016] [Indexed: 06/06/2023]
Abstract
The trachea has a complex anatomy to fulfill its tasks. Its unique fibro-cartilaginous structure maintains an open conduit during respiration, and provides vertical elasticity for deglutition, mobility of the neck and speech. Blood vessels pierce the intercartilaginous ligaments to perfuse the ciliated epithelium, which ensures effective mucociliary clearance. Removal of a tracheal segment affected by benign or malignant disease requires airtight restoration of the continuity of the tube. When direct approximation of both tracheal ends is no longer feasible, a reconstruction is needed. This may occur in recurrent short-segment defects in a scarred environment, or in defects comprising more than half the length of the trachea. The resulting gap must be filled with vascularized tissue that restores the mucosal lining and supports the semi-rigid, semi-flexible framework of the trachea. For long-segment or circular defects, restoration of this unique biomechanical profile becomes even more important. Due to the inherent difficulty of creating such a tube, a tracheostomy or palliative stenting are often preferred over permanent reconstruction. To significantly improve and sustain quality of life of these patients, surgeons proposed innovative strategies for complex tracheal repair. In this review, we provide an overview of current clinical applications of tracheal repair using autologous and allogenic tissues. We look at recent advances in the field of tissue engineering, and the areas for improvement of these first human applications. Lastly, we highlight the focus of our research, in an effort to contribute to the development of optimized tracheal reconstructive techniques.
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Affiliation(s)
- Margot Den Hondt
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Jeroen Vranckx
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium.
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13
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Hofferberth SC, Watters K, Rahbar R, Fynn-Thompson F. Evolution of Surgical Approaches in the Management of Congenital Tracheal Stenosis. World J Pediatr Congenit Heart Surg 2015; 7:16-24. [DOI: 10.1177/2150135115606627] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Congenital tracheal stenosis (CTS) is a serious and rare condition that often presents a complex surgical challenge. We reviewed the evolution of surgical approaches to the management of CTS at a single institution. Methods: We conducted a retrospective clinical review of all patients who underwent surgical repair of CTS at our institution. From January 1992 to January 2014, a total of 30 patients (median age 92 days; range 3 days-1.7 years) underwent surgery for CTS at our institution. Techniques included slide tracheoplasty (n = 16), tracheal resection (n = 10), pericardial patch tracheoplasty (n = 3), and costal cartilage tracheoplasty (n = 1). Twenty-two (73%) patients had associated intracardiac or great vessel anomalies, including 18 (60%) with left pulmonary artery sling. Five (17%) patients had associated single lung malformation. All procedures were performed via a median sternotomy with cardiopulmonary bypass. Results: Median postoperative length of stay was 25 days (range, 5-431 days). Late airway reintervention was required in seven (26%), including two (15%) infants after slide tracheoplasty, two (22%) posttracheal resection, and two (100%) post pericardial patch tracheoplasty. The one patient who underwent costal cartilage tracheoplasty required multiple reinterventions. Overall mortality was 13% (n = 4), two deaths occurred post slide tracheoplasty, one death occurred after tracheal resection, and one after pericardial patch tracheoplasty, respectively. Conclusion: Slide tracheoplasty is the procedure of choice for repair of CTS, while tracheal resection is a viable option for patients with discreet, short-segment stenosis.
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Affiliation(s)
- Sophie C. Hofferberth
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen Watters
- Department of Otolaryngology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Reza Rahbar
- Department of Otolaryngology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Francis Fynn-Thompson
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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14
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Mehta AC, Thaniyavarn T, Ghobrial M, Khemasuwan D. Common Congenital Anomalies of the Central Airways in Adults. Chest 2015; 148:274-287. [PMID: 25811532 DOI: 10.1378/chest.14-1788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The knowledge of airway anatomy is the most fundamental requirement of every bronchoscopist. There are numerous and frequent anatomic variations of the central airways making the examination unique for every individual. It is imperative for every bronchoscopist to be fully cognizant of the common congenital anomalies involving the central airways. Proper identification and reporting of these findings are a matter of the utmost importance, especially when surgical options in a patient with lung cancer or lung transplantation is under consideration. This article focuses on the congenital anomalies of central airway encountered among adults. Each of these anatomic variations has a characteristic appearance, yet requires bronchoscopic acumen for their identification. This review provides a comprehensive description of these anomalies and highlights their clinical implications.
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Affiliation(s)
- Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Tany Thaniyavarn
- Department of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, GA
| | - Michael Ghobrial
- Internal Medicine Department, Fairview Hospital, a Cleveland Clinic Hospital, Cleveland, OH
| | - Danai Khemasuwan
- Interventional Pulmonary Medicine, Henry Ford Hospital, Detroit, MI
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15
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Xue B, Liang B, Wang S, Zhu L, Lu Z, Xu Z. One-Stage Surgical Correction of Congenital Tracheal Stenosis Complicated with Congenital Heart Disease in Infants and Young Children. J Card Surg 2014; 30:97-103. [DOI: 10.1111/jocs.12418] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- BangDe Xue
- Department of Cardiothoracic Surgery; Shanghai Children's Medical Center; Shanghai China
- Department of Cardiac Surgery, Rui Jin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - BeiBei Liang
- Shanghai Medical Instrument College; University of Shanghai for Science and Technology; Shanghai China
| | - Shunmin Wang
- Department of Cardiothoracic Surgery; Shanghai Children's Medical Center; Shanghai China
| | - LiMin Zhu
- Department of Cardiothoracic Surgery; Shanghai Children's Medical Center; Shanghai China
| | - ZhaoHui Lu
- Department of Cardiothoracic Surgery; Shanghai Children's Medical Center; Shanghai China
| | - Zhiwei Xu
- Department of Cardiothoracic Surgery; Shanghai Children's Medical Center; Shanghai China
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16
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Fishman JM, Lowdell M, Birchall MA. Stem cell-based organ replacements-airway and lung tissue engineering. Semin Pediatr Surg 2014; 23:119-26. [PMID: 24994525 DOI: 10.1053/j.sempedsurg.2014.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Tissue engineering requires the use of cells seeded onto scaffolds, often in conjunction with bioactive molecules, to regenerate or replace tissues. Significant advances have been made in recent years within the fields of stem cell biology and biomaterials, leading to some exciting developments in airway tissue engineering, including the first use of stem cell-based tissue-engineered tracheal replacements in humans. In addition, recent advances within the fields of scaffold biology and decellularization offer the potential to transplant patients without the use of immunosuppression.
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Affiliation(s)
- Jonathan M Fishman
- UCL Centre for Stem Cells, Tissue Engineering and Regenerative Medicine, London, UK; The Royal National Throat, Nose and Ear Hospital, London, UK; UCL Ear Institute, University College London, 332 Gray׳s Inn Road, London WC1X 8EE, UK
| | - Mark Lowdell
- Department of Haematology, Royal Free Hospital, UCL, London, UK
| | - Martin A Birchall
- UCL Centre for Stem Cells, Tissue Engineering and Regenerative Medicine, London, UK; The Royal National Throat, Nose and Ear Hospital, London, UK; UCL Ear Institute, University College London, 332 Gray׳s Inn Road, London WC1X 8EE, UK.
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17
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Aaltonen PL, Puntila JT, Suominen PK, Mattila IP, Sairanen HI, Lindahl H, Salminen JT. Resection of the stenotic segment with individually tailored anastomosis for symptomatic congenital tracheal stenosis in infants. Eur J Cardiothorac Surg 2014; 45:e215-9. [PMID: 24682872 DOI: 10.1093/ejcts/ezu113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse retrospectively population-based results of congenital tracheal stenosis (CTS) repair in infants in Finland. METHODS Data on infants who were operated on for CTS in Helsinki Children's Hospital between August 1988 and May 2013 were analysed retrospectively. Fibreoptic bronchoscopy was performed perioperatively and in follow-up of all the surviving patients. The median follow-up time was 7 (range 1-20) years. RESULTS Thirteen infants were operated on for CTS. Resection of the stenotic segment with individually tailored anastomosis was used in 12 patients and slide tracheoplasty in 1 patient. The median age at the operation was 2.9 (range 0.2-19) months. Eight (62%) patients had associated cardiovascular defects, which were corrected during the same operation. The median length of stenosis was 35% (range 25-60%) of the total length of the trachea. The median length of time of postoperative mechanical ventilation was 10 (range 5-19) days. The median length of time of intensive care treatment was 15 (range 7-40) days. One patient died from hypoplastic lung tissue and fibrosis, and multiorgan failure. One patient required reoperation, and 3 other patients received balloon bronchodilatations postoperatively. There was no late mortality. All of the 12 survivors had a good outcome. CONCLUSION Resection with individually tailored anastomosis with up to 55% of the stenotic segment of the trachea presented a good long-term outcome.
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Affiliation(s)
- Panu L Aaltonen
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Juha T Puntila
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Pertti K Suominen
- Department of Paediatric Anaesthesiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Ilkka P Mattila
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Heikki I Sairanen
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Harry Lindahl
- Department of Paediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Jukka T Salminen
- Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
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18
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Yazdanbakhsh AP, van Rijssen LB, Koolbergen DR, König A, de Mol BAJM, Hazekamp MG. Long-term follow-up of tracheoplasty using autologous pericardial patch and strips of costal cartilage. Eur J Cardiothorac Surg 2014; 47:146-52; discussion 152. [PMID: 24648427 DOI: 10.1093/ejcts/ezu101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate long-term results of tracheoplasty using autologous pericardial patch and strips of costal cartilage for relieving severe long-segment tracheal stenosis. METHODS Data were collected retrospectively by clinical chart review. Between 1995 and 2013, 21 patients underwent tracheoplasty. Follow-up was performed by outpatient chart review; otherwise, referring physicians and parents were contacted and asked to fill in a questionnaire. RESULTS Median age at the time of operation was 0.9 (range 0.5-44) years. Aetiology of tracheal stenosis was double aortic arch in 9 patients, right arch with a left ductus in 3, innominate artery compression in 1 patient, complete tracheal rings in 7, 3 of whom with pulmonary artery sling and 2 with agenesis of one lung, and other causes in 1 patient. Previous surgery was performed in 6 (29%) patients. Patch tracheoplasty was performed using autologous pericardial patch and external stenting using costal cartilage. Major complications were mediastinitis and patch dehiscence in 2 patients, 2 patients needed tracheal cannula and 1 patient had stent implantation. Three (14%) patients died in the late postoperative period: 1 patient died of sepsis, 1 had patch dehiscence and 1 erosion of tracheal stent and consequently intractable bleeding. Follow-up was 6.1±2.7 years (0.75-10 years). At follow-up, 2 (11%) patients were still symptomatic, 4 (22%) had occasionally mild symptoms and 12 (67%) were free of symptoms. CONCLUSIONS Treatment for severe tracheal stenosis remains challenging. With tracheoplasty using autologous pericardial patch and strips of costal cartilage, long and narrow tracheal stenosis can be repaired. There are no limitations as to the length and location and severity of the stenosis. Tracheoplasty is associated with a high complication rate. A multidisciplinary approach is mandatory to ensure favourable long-term outcomes.
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Affiliation(s)
- Aria P Yazdanbakhsh
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands
| | - Lennart B van Rijssen
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands
| | - David R Koolbergen
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands
| | - Astrid König
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands
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19
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Yong MS, d'Udekem Y, Robertson CF, Butt W, Brizard CP, Konstantinov IE. Tracheal repair in children: reduction of mortality with advent of slide tracheoplasty. ANZ J Surg 2013; 84:748-54. [DOI: 10.1111/ans.12132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Matthew S. Yong
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Yves d'Udekem
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Colin F. Robertson
- Department of Respiratory Medicine; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Warwick Butt
- Department of Intensive Care; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Christian P. Brizard
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
| | - Igor E. Konstantinov
- Department of Cardiothoracic Surgery; Royal Children's Hospital; Melbourne Victoria Australia
- The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
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20
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Coticchia JM, Cohen D, Sachdeva L. Grand challenges in pediatric otolaryngology. Front Pediatr 2013; 1:10. [PMID: 24400256 PMCID: PMC3860887 DOI: 10.3389/fped.2013.00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/01/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
- James M Coticchia
- Division of Pediatric Otolaryngology, Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
| | - David Cohen
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
| | - Livjot Sachdeva
- Division of Pediatric Otolaryngology, Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Wayne State University Detroit, MI, USA
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21
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Lovett M, Entrikin D, Ungerleider R, Ootaki Y. Pulmonary artery sling and tracheal bronchus presenting in a 2-year-old child. Ann Thorac Cardiovasc Surg 2012. [PMID: 23196661 DOI: 10.5761/atcs.cr.12.01971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pulmonary artery sling is an incomplete vascular ring, the result of the left pulmonary artery arising from the right pulmonary artery and effectively constricting the airway, and it usually presents within the first weeks to months of life. We report a surgical correction of tracheal stenosis for a two-year-old patient associated with pulmonary artery sling and tracheal broncus.
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Affiliation(s)
- Marlina Lovett
- Division of Pediatric Cardiothoracic Surgery, Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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22
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Tsukada H, Majid A, Kent MS, Ernst A, DeCamp MM, Gangadharan SP. Two-Stage End-to-End Reconstruction of Long-Segment Tracheal Defects With a Bioabsorbable Scaffold Grafting Technique in a Canine Model. Ann Thorac Surg 2012; 93:1088-92. [DOI: 10.1016/j.athoracsur.2012.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 01/04/2012] [Accepted: 01/06/2012] [Indexed: 10/28/2022]
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23
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Manning PB, Rutter MJ, Lisec A, Gupta R, Marino BS. One slide fits all: The versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children. J Thorac Cardiovasc Surg 2011; 141:155-61. [DOI: 10.1016/j.jtcvs.2010.08.060] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 08/07/2010] [Accepted: 08/29/2010] [Indexed: 11/15/2022]
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24
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Backer CL, Holinger LD. A History of Pediatric Tracheal Surgery. World J Pediatr Congenit Heart Surg 2010; 1:344-63. [DOI: 10.1177/2150135110381602] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tracheal stenosis in children is primarily caused by congenital complete cartilage tracheal rings. These infants present with severe respiratory distress early in life. The purpose of this review is to examine the history of surgical intervention for infants and children with congenital tracheal stenosis. Most of the significant advances in the surgical treatment of patients with congenital tracheal stenosis have occurred over the past 50 years. The highlights of the historical events include the first pulmonary artery sling repair (1953), tracheal resection (1958), cartilage tracheoplasty (1981), pericardial tracheoplasty (1982), slide tracheoplasty (1989), homograft tracheoplasty (1994), and tracheal autograft (1996). The results of surgical intervention on patients with congenital tracheal stenosis have steadily improved, particularly during the past 20 years. Most successful centers are using cardiopulmonary bypass, simultaneous repair of associated pulmonary artery sling and cardiac anomalies, and the current procedure of choice—slide tracheoplasty. During the past 50 years, significant advances have been made in the care of infants with congenital tracheal stenosis. The outlook for these children is currently quite good, and successful outcomes are particularly evident at institutions with a careful multidisciplinary approach to these patients.
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Affiliation(s)
- Carl L. Backer
- Division of Cardiovascular-Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lauren D. Holinger
- Division of Otolaryngology, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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