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Sheffield CD, Bryton C, Scott AR. Choice of suture technique may mitigate figure-of-8 deformity in slide tracheoplasty. Am J Otolaryngol 2024; 45:104318. [PMID: 38678801 DOI: 10.1016/j.amjoto.2024.104318] [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: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To demonstrate varying degrees of immediate postoperative figure of 8 deformity following three different methods of tracheal suturing. STUDY DESIGN Comparative ex-vivo study. METHODS A fresh, unfixed rabbit trachea was harvested and bisected at its midpoint. The posterior membranous trachea was excised from both segments to mimic the anatomy of complete tracheal rings following longitudinal release. A slide tracheoplasty was performed on the same tracheal segments as an internal control, using three different methods of closure: simple running, running horizontal mattress, and a modified baseball stitch. Endoscopic and external photographs were taken immediately following repair to document the effect of closure technique on external and endoluminal anatomy. RESULTS A simple running closure, in which traveling occurs between needle passes, showed the greatest degree of postoperative figure of 8 deformity. A running horizontal mattress suture closure showed less deformity and a modified running closure, in which traveling occurs within needle passes, showed the least deformity. CONCLUSIONS Our study suggests that a minor modification of standard running closure techniques may help limit the common figure-of-8 deformity often noted following slide tracheoplasty. LAY SUMMARY Figure of-8 deformity is a problem that can occur when repairing a narrow trachea referred to as tracheal stenosis. This deformity may be prevented using particular suture techniques which may decrease the likelihood that the trachea becomes blocked again following repair.
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Affiliation(s)
- Cedric Dewayne Sheffield
- Department of Otolaryngology-Head & Neck Surgery, Tufts University School of Medicine, PO Box 850, 800 Washington St, Boston, MA 02111, USA
| | - Corey Bryton
- Department of Otolaryngology-Head & Neck Surgery, Tufts University School of Medicine, PO Box 850, 800 Washington St, Boston, MA 02111, USA
| | - Andrew R Scott
- Department of Otolaryngology-Head & Neck Surgery, Tufts University School of Medicine, PO Box 850, 800 Washington St, Boston, MA 02111, USA.
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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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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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Bae SY, Lee JH, Kwon HW, Cho S, Kwon C, Kim WH, Kwak JG. Outcomes of not using tracheoplasty in asymptomatic tracheal stenosis found during open-heart surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae030. [PMID: 38441273 PMCID: PMC10948281 DOI: 10.1093/icvts/ivae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/02/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES We aimed to review the outcomes of treating incidentally encountered asymptomatic airway stenosis during open-heart surgery conservatively without the use of tracheoplasty. METHODS Between January 2002 and October 2022, 25 patients were incidentally diagnosed with tracheal stenosis during open-heart surgery. Intraoperative bronchoscopy and/or laryngoscopy revealed tracheal stenosis; however, this was not consistent with the findings of the preoperative computed tomography. Patients who were diagnosed with a pulmonary artery or vascular sling or had moderate-to-severe respiratory symptoms before open-heart surgery were excluded. RESULTS The median age and weight of the patients at operation were 3.0 months and 5.1 kg, respectively. They were categorized as those having tracheal stenosis on preoperative computed tomography (n = 12) or not having tracheal stenosis (n = 13). The narrowest diameter was significantly smaller in the former group (3.0 vs 5.8 mm, P < 0.05). The rates of reintubation and the tracheostomy, and intubation days tended to be higher in former group without statistical significance. Stenotic degree improved 2 months and 1 year or more after the operation (39.3% at operation, 28.4% at 2 months, 12.5% after 1 year). All patients were Ross class 1 or 2 at follow-up (mean, 7.1 years). CONCLUSIONS Patients with tracheal stenosis showed tolerable long-term outcomes without using tracheoplasty. Accordingly, if tracheal stenosis, that would cause intubation difficulty, was incidentally revealed, concomitant tracheoplasty may not be required during open-heart surgery if the stenosis did not cause considerable symptoms or signs preoperatively.
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Affiliation(s)
- Seon Yong Bae
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chiheon Kwon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Zhou M, Zhong LL, Huang H, Lin L, Chen M, Ding XF. [The role of bronchoscopy in slide tracheoplasty in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:527-533. [PMID: 37272181 PMCID: PMC10247194 DOI: 10.7499/j.issn.1008-8830.2211012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/10/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To study the role of bronchoscopy in slide tracheoplasty. METHODS A retrospective analysis was conducted on the diagnosis and treatment of four children with tracheal stenosis admitted to Hunan Provincial People's Hospital from 2017 to 2020. The role of bronchoscopy was summarized in the preoperative evaluation, intraoperative positioning and measurement, and postoperative wound evaluation and treatment during slide tracheoplasty. RESULTS Bronchoscopy evaluation before slide tracheoplasty showed that 3 of the 4 children had complete trachea rings, 2 had pulmonary artery sling, and 2 had multiple stenosis. Slide tracheoplasty was performed in the hospital on 3 children, and the midpoint of the stenosis segment was judged under bronchoscopy, and the length of the stenosis segment was measured, which assisted in the resection of the stenosis segment of the trachea. The pathogens were identified by lavage after the surgery. One child who developed scar traction 9 months after slide tracheoplasty in another hospital was improved by interventional treatment under bronchoscopy. Mucosal changes were found under bronchoscopy in 2 children 4 days after surgery, and the treatment plan was adjusted. One month after surgery, 2 children had granulation hyperplasia, which was improved by cryotherapy under bronchoscopy. One child abandoned treatment due to anastomotic necrosis and died. Three survivors were followed up for over 6 months with good prognosis, but all had tracheobronchial malacia. CONCLUSIONS Bronchoscopy can be used for the management of slide tracheoplasty in children with tracheal stenosis, which is helpful to postoperative rehabilitation and follow-up.
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Affiliation(s)
- Miao Zhou
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Li-Li Zhong
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Han Huang
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Lin Lin
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Min Chen
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
| | - Xiao-Fang Ding
- Children's Medical Center, Hunan Provincial People's Hospital, Changsha 410000, China
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Lee HY, Lee JW. Current Status and Future Outlook of Additive Manufacturing Technologies for the Reconstruction of the Trachea. J Funct Biomater 2023; 14:jfb14040196. [PMID: 37103286 PMCID: PMC10141199 DOI: 10.3390/jfb14040196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Tracheal stenosis and defects occur congenitally and in patients who have undergone tracheal intubation and tracheostomy due to long-term intensive care. Such issues may also be observed during tracheal removal during malignant head and neck tumor resection. However, to date, no treatment method has been identified that can simultaneously restore the appearance of the tracheal skeleton while maintaining respiratory function in patients with tracheal defects. Therefore, there is an urgent need to develop a method that can maintain tracheal function while simultaneously reconstructing the skeletal structure of the trachea. Under such circumstances, the advent of additive manufacturing technology that can create customized structures using patient medical image data provides new possibilities for tracheal reconstruction surgery. In this study, the three-dimensional (3D) printing and bioprinting technologies used in tracheal reconstruction are summarized, and various research results related to the reconstruction of mucous membranes, cartilage, blood vessels, and muscle tissue, which are tissues required for tracheal reconstruction, are classified. The prospects for 3D-printed tracheas in clinical studies are also described. This review serves as a guide for the development of artificial tracheas and clinical trials using 3D printing and bioprinting.
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Affiliation(s)
- Hwa-Yong Lee
- Division of Science Education, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Jin Woo Lee
- Department of Molecular Medicine, College of Medicine, Gachon University, Incheon 21999, Republic of Korea
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Outcomes of slide tracheoplasty for congenital tracheal stenosis in 80 children: A 22-year single-center experience. J Pediatr Surg 2022; 57:1205-1209. [PMID: 35437172 DOI: 10.1016/j.jpedsurg.2022.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE The application of slide tracheoplasty (STP) in the treatment of congenital tracheal stenosis (CTS) has improved patient outcomes over the past few decades. We reviewed our experiences with the procedure, elucidated risk factors, and discussed important aspects of perioperative management to improve outcomes. METHOD Patients with CTS undergoing STP between July 1998 and December 2020 were enrolled. Patient characteristics, perioperative condition, management, operative details, and outcomes, including mortality and postoperative intervention, were collected from medical records. RESULTS Eighty patients underwent STP. Sixty-five patients (81.3%) had an associated cardiovascular anomaly. Thirteen patients (16.3%) had unilateral lung agenesis or hypoplasia. Preoperative mechanical ventilation was necessary in 54 (67.5%) patients, and extracorporeal membrane oxygenation (ECMO) was required in eight patients (10.0%). An endotracheal tube was placed before the stenotic entrance to avoid granulation. During STP, the trachea was dissected as little as possible to maintain the blood supply. The one-year survival rate was 88.8% (nine patients died). One patient (1.3%) required postoperative balloon dilation, and none required stenting or granulation removal. Of the survivors, 62 (92.5%) achieved successful extubation without tracheostomy. Multivariable analysis revealed complex cardiovascular anomaly (P = 0.05) and preoperative ECMO (P = 0.019) to be adverse predictors of survival. CONCLUSION Although STP can be performed successfully in CTS patients, surgeons and families should be aware of factors that may lead to a more difficult postoperative course or increase the mortality. Meticulous, perioperative positioning of the endotracheal tube and preserving the tracheal blood flow can minimize the need for postoperative intervention.
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8
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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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Wen W, Du X, Zhu L, Wang S, Xu Z, Lu Z. Surgical management of long-segment congenital tracheal stenosis with tracheobronchial malacia. Eur J Cardiothorac Surg 2021; 61:1001-1010. [PMID: 34940823 DOI: 10.1093/ejcts/ezab551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/17/2021] [Accepted: 11/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Slide tracheoplasty has become the mainstream treatment for long-segment congenital tracheal stenosis (LSCTS). However, technical improvements are still needed to improve the clinical outcomes of patients exhibiting LSCTS with tracheobronchial malacia. METHODS LSCTS patients who underwent tracheoplasty from January 2010 to December 2020 were reviewed. According to the time of surgical technique modifications for reconstructing a supportive carina, the patients were divided into 2 groups: group A (2010-2018) and group B (2019-2020). We identified a well-balanced cohort matched by propensity score to evaluate the differences in surgical outcomes between the 2 groups. RESULTS There were no significant differences between group A and group B in any of the 8 characteristics before and after propensity score matching. In the propensity score-matched cohort, the number of patients who accepted anterior carina tracheopexy (75/77 vs 4/77, P < 0.001) and in situ pericardium insertion (75/77 vs 14/77, P < 0.001) in group B was significantly greater than that in group A. The mechanical ventilation time [48.3 (interquartile range: 29.6, 116.3) h vs 73.3 (interquartile range: 47.9, 111.6) h, P = 0.009] and cumulative mortality (P = 0.023) were significantly lower in Group B than Group A. CONCLUSIONS Reconstructing a supportive, stable carina of the neotrachea and tracheobronchopexy are helpful to improve the outcomes of slide tracheoplasty.
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Affiliation(s)
- Wanyu Wen
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xinwei Du
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Limin Zhu
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shunmin Wang
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiwei Xu
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhaohui Lu
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Alkhasov A, Razumovsky A, Gusev A, Tepaev R, Ratnikov S, Lezhnev A, Romanova E, Komina E, Saveleva M, Dyakonova E, Yatzik S. Surgical Treatment of Patients with Full Tracheal Rings: Our Experience. J Laparoendosc Adv Surg Tech A 2021; 31:1511-1515. [PMID: 34847727 DOI: 10.1089/lap.2021.0337] [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: 11/13/2022] Open
Abstract
Introduction: Complete tracheal rings are a rare pathology occurring in 1 out of 100,000 live births. It is rare isolated tracheal or tracheobronchial anomaly resulting from abnormal cartilage growth, forming a complete ring, and leading to airway stenosis. A sliding tracheoplasty, primarily described by Tsang et al. and later widely presented by Grillo et al., overlaps the tracheal stenosing segments and shortens the trachea itself, and thus increases the diameter and circumference of the stenosing area double up. Materials and Methods: We have performed four slide tracheoplasties in the period between February 2019 and December 2020 in children who underwent medical treatment in the department of thoracic surgery in our center. Median age was 10 ± 5.5 months (2 months-1 year 6 months). Median weight was 6.9 ± 1.9 kg (4.5-9 kg). Slide tracheoplasty was performed using central venoarterial extracorporeal membrane oxygenation in 3 cases and using cardiopulmonary bypass in 1 case. Results: Patients were on artificial lung ventilation for 2-6 days in the postoperative period. Patients were discharged 14-18 days after the surgery. There were no lethal outcomes in our study. Discussion: Long segment congenital tracheal stenosis is an often and serious life-threatening anatomical malformation that bounded the length of trachea >50%. There is no unique treatment strategy for patients with such pathology. Sliding tracheoplasty can be recommended for all, but not for the shortest segments of stenosis, as it creates permissible voltage fluctuations during tracheal anastomosis. Excellent results in management of such severe patients can be achieved only through the collaboration of multidisciplinary team of specialists sharing organized and consistent patient-oriented approach.
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Affiliation(s)
- Abdumanap Alkhasov
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexander Razumovsky
- State Budgetary Educational Institution of Higher Professional Education "Russian National Research Medical University named after N.I. Pirogov" Ministry of Health of Russia, Moscow, Russian Federation
| | - Alexey Gusev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation.,RUDN University (Peoples' Friendship University of Russia), Moscow, Russian Federation
| | - Rustem Tepaev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Sergey Ratnikov
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexandr Lezhnev
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Ekaterina Romanova
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Elena Komina
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Maria Saveleva
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Elena Dyakonova
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Sergey Yatzik
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" Of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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Fujieda Y, Morita K, Otake S, Kasai M, Hatakeyama T. Infectious complications after tracheoplasty for congenital tracheal stenosis: a retrospective comparative study. Pediatr Surg Int 2021; 37:1737-1741. [PMID: 34453197 DOI: 10.1007/s00383-021-04996-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The factors related to infectious complications after tracheoplasty for congenital tracheal stenosis (CTS) remain unclear; we, therefore, assessed these factors in this study. METHODS We divided 47 patients who underwent slide tracheostomy and tracheal resection for CTS between May 2016 and December 2020 into an infected group and a non-infected group. Their characteristics were compared between groups. Results are presented as the median (range) or incidence. RESULTS Infectious complications were observed in 12 patients (25.5%). Empyema and mediastinitis were seen in 5 cases (10.6%). There was a significant difference in the following factors in the infected and non-infected groups, respectively: weight, 5457 (2868-20,750) g and 6554 (2275-20,800) g (p = 0.025); surgical time, 575.5 (313-646) min and 349 (270-651) min (p < 0.001); extracorporeal circulation time, 303.5 (186-610) min and 216 (117-478) min (p = 0.001); and postoperative intubation time, 13 (7-28) days, and 6 (5-22) days (p < 0.001). Age, malnutrition, cardiovascular comorbidities, and preoperative methicillin-resistant Staphylococcus aureus detection were not significantly different between the two groups. CONCLUSION There were a few serious infectious complications and no perioperative deaths. Attention should be paid to low body weight, long surgical and extracorporeal circulation time, and intubation time in relation to infectious complications.
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Affiliation(s)
- Yuki Fujieda
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan.
| | - Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan
| | - Shogo Otake
- Division of Infectious Disease, Department of Pediatrics, Kobe Children's Hospital, Kobe, Japan
| | - Masashi Kasai
- Division of Infectious Disease, Department of Pediatrics, Kobe Children's Hospital, Kobe, Japan
| | - Tadashi Hatakeyama
- Department of Pediatric Surgery, Kobe Children's Hospital, 1-6-7, Minatojima Minami-cho, Chuo-ku, Kobe, 650-0047, Japan
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12
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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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Yu D, Guo Z, You X, Peng W, Qi J, Sun J, Wu K, Li X, Mo X. Long-term outcomes in children undergoing vascular ring division: a multi-institution experience. Eur J Cardiothorac Surg 2021; 61:605-613. [PMID: 34632492 PMCID: PMC8858591 DOI: 10.1093/ejcts/ezab432] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Vascular rings are rare anomalies of congenital heart disease that cause respiratory and gastrointestinal symptoms. This study assessed the long-term outcomes of patients with vascular ring division. METHODS A multi-institution retrospective review of 371 patients with vascular rings undergoing surgical division at 3 paediatric cardiac institutions between November 2007 and October 2019 was performed. RESULTS The complete vascular rings consisted of a double aortic arch (24.5%), right aortic arch with left ligamentum arteriosum (36.7%) and left aortic arch, with right ligamentum arteriosum (0.5%). The incomplete vascular rings consisted of a pulmonary artery sling (22.9%), left aortic arch with aberrant right subclavian artery (15.1%) and innominate artery compression syndrome (0.3%). Respiratory symptoms included stridor (71.4%), wheezing (49.1%), coughing (31.5%), gastrointestinal symptoms included choking (12.4%), dysphagia (3.2%) and emesis (1.9%). Only one patient died after discharge, yielding a late mortality rate of 0.3% (1/360). The 10-year overall survival rate was 96.8%. Postoperative complications were reported in 51 patients, 15 of whom required reoperation. The 10-year freedom from reoperation rate was 95.9%. Follow-up was completed in 95.4% (354/371) of patients, with a mean follow-up time of 4.3 ± 2.9 years (range from 1 to 13 years). Twenty patients (5.6%) experienced residual symptoms during long-term follow-up. CONCLUSIONS The outcomes of vascular ring division are excellent. A Kommerell diverticulum >1.5 times the aberrant left subclavian artery origin is an operative indication for primary resection. Tracheomalacia is a risk factor for reoperation and residual symptoms, and preoperative fibrobronchoscopy is important for evaluation.
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Affiliation(s)
- Di Yu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhangke Guo
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin You
- Department of Cardiac Surgery, Children's Hospital of Suqian, Suqian, China
| | - Wei Peng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jirong Qi
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Sun
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Kaihong Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaofeng Li
- Department of Cardiac Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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Pola Dos Reis F, Minamoto H, Bibas BJ, Minamoto FEN, Cardoso PFG, Caneo LF, Pêgo-Fernandes PM. Treatment of tracheal stenosis with extracorporeal membrane oxygenation support in infants and newborns. Artif Organs 2021; 45:748-753. [PMID: 33350476 DOI: 10.1111/aor.13898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022]
Abstract
Tracheal stenosis in children is a challenge for the healthcare team, since it is a rare disease. Patients usually have other clinical comorbidities, mainly previous cardiac surgical interventions. This retrospective single-center study included infants with tracheal stenosis (congenital or acquired) operated between 2016 and 2020 on venoarterial extracorporeal membrane oxygenation (VA ECMO). Five patients were operated and the median age of detection of the tracheal disease was 3.7 months, and the median age at the operation was 5 months. All patients had associated cardiac anomalies. Four patients had congenital tracheal stenosis; two with associated pig bronchus. One patient had acquired subglottic stenosis with concomitant stenosis at the carina. After the operation, the patients were referred to ICU on ECMO with an open chest. Minor ECMO-related complications occurred in two patients (hemothorax and wound infection). All patients required endoscopic evaluation during the postoperative care; median of 3.2 procedures. Two patients are currently in follow-up and three have died. Slide tracheoplasty with VA-ECMO can be successfully performed in infants with prior cardiac surgery. Nevertheless, a difficult postoperative course should be anticipated, with possible prolonged ECMO use, readmissions, and higher morbidity and mortality than in children with tracheal stenosis alone.
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Affiliation(s)
- Flavio Pola Dos Reis
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Grupo de ECMO, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Helio Minamoto
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Benoit Jacques Bibas
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabio Eiti Nishibe Minamoto
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Luiz Fernando Caneo
- Grupo de ECMO, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Divisao de Cirurgia Pediatrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Disciplina de Cirurgia Toracica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Abstract
OBJECTIVE Review a single-centre experience with pulmonary artery sling repair and evaluate risk factors for re-intervention. METHODS Patients with surgically repaired pulmonary artery sling at a single institution between 1996 and 2018 were retrospectively reviewed. A univariate Cox regression analysis was used to evaluate variables for association with freedom from re-intervention. RESULTS Eighteen patients had pulmonary artery sling repair. At operation, median age and weight were 6.9 months (interquartile range 4.1-18.1) and 9.5 kg (interquartile range 6.5-14.5), respectively. A median hospital length of stay was 12 days (interquartile range 5.8-55.3). Twelve patients (67%) had complete tracheal rings, of whom six (50%) underwent tracheoplasty (five concurrently with pulmonary artery sling repair). Airway re-intervention was required in five (83%) of the six patients who underwent tracheoplasty. One patient had intraoperative diagnosis and repair of pulmonary artery sling during unrelated lesion repair and required tracheoplasty 24 days post-operatively. One patient died 55 days after pulmonary artery sling repair and tracheoplasty following multiple arrests and re-interventions. Median post-operative follow-up for surviving patients was 6.3 years (interquartile range 11 months-13 years), at which time freedom from re-intervention was 61%. When controlling for patient and tracheal size, initial tracheoplasty was associated with decreased freedom from re-intervention (hazard ratio 21.9, 95% confidence interval 1.7-284.3, p = 0.018). CONCLUSIONS In patients with pulmonary artery sling, tracheoplasty is associated with decreased freedom from re-intervention. In select patients with pulmonary artery sling and complete tracheal rings, conservative management without tracheoplasty is feasible. Further study is necessary to delineate objective indications for tracheoplasty.
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Stramiello JA, Mohammadzadeh A, Ryan J, Brigger MT. The role of bioresorbable intraluminal airway stents in pediatric tracheobronchial obstruction: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 139:110405. [PMID: 33017664 DOI: 10.1016/j.ijporl.2020.110405] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Tracheal stenosis and tracheobronchomalacia are complicated, patient-specific diseases that can be treated with intraluminal stenting. Most commonly, silicone and metal stents are utilized, however, they pose significant early and late morbidity and are further complicated by growth of the airway in the pediatric population. Given recent improvements in materials science, there is a growing body of evidence suggesting a strong role for bioresorbable intraluminal stents in treating pediatric tracheobronchial obstruction. METHODS A PubMed.gov literature search was performed on December 3, 2019 and May 15, 2020, and a 2-researcher systematic review was performed following the PRISMA criteria. The following search query was utilized: (((((((bioresorbable) OR bioabsorbable) OR resorbable) OR absorbable) OR biodegradable AND airway) OR trachea) AND stent. A pooled statistical analysis was performed on all reported pediatric patients using SPSS software. RESULTS 1369 publications were screened and 26 articles with original data were identified. Materials used included polydioxanone (PDO), poly-l-lactic acid (PLLA), polyglycolic acid/poly-l-lactide co-polymer with Proglactin 910 (Vicryl®-PDS®), polycaprolactone (PCL), magnesium alloys, and co-polymers in varying proportions. Twelve articles presented data on human subjects, 8 of which were case series and case reports on pediatric populations using polydioxanone (PDO) stents. Pooled statistical analysis demonstrated an average age of 19 months (range 0.25-144), 56.5% associated with a cardiovascular anomaly, and overall complication rate of 21.7%, with a stent fragment foreign body being the most common (8.7%), followed by significant granulation tissue (4.3%), stent migration (4.3%), and local stenosis (4.3%). Comparative analysis demonstrated short-term improvement (up to 1 month) has a statistically significant association with tracheobronchomalacia versus tracheal stenosis on chi-squared test (p = 0.001). The remaining analyses did not yield statistical significance. CONCLUSION The reported application of bioresorbable materials as intraluminal airway stents is positive. All comparative animal studies report biocompatibility and fewer morbidities compared to metal and silicone stents, however, in human studies there are concerns over the short interval of degradation and the potential for obstructive foreign bodies in poorly seated stents. Overall, there are clear, reproducible advantages to bioresorbable intraluminal stents in pediatric airway obstruction, as well as common pitfalls, that warrant further research.
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Affiliation(s)
- Joshua A Stramiello
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA, 92103, USA
| | - Amir Mohammadzadeh
- UC San Diego School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - Justin Ryan
- 3D Innovations Lab, Rady Children's Hospital, San Diego, CA, 3020 Children's Way MC5166, San Diego, CA, 92123, USA
| | - Matthew T Brigger
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA, 92103, USA; Division of Pediatric Otolaryngology, Department of Surgery, Rady Children's Hospital, San Diego, CA, 3020 Children's Way, San Diego, CA, 92123, USA.
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Bryant R. Commentary: Reducing the Recurrence of Airway Stenosis After Slide Tracheoplasty. Semin Thorac Cardiovasc Surg 2020; 32:935. [PMID: 32610200 DOI: 10.1053/j.semtcvs.2020.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Roosevelt Bryant
- Division of Congenital Heart Surgery, The Heart Center, Phoenix Children's Hospital, Phoenix, Arizona.
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18
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Intermediate-Term Outcomes of Slide Tracheoplasty in Pediatric Patients With Ring-Sling Complex. Ann Thorac Surg 2020; 109:820-827. [DOI: 10.1016/j.athoracsur.2019.06.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
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Outcome of congenital tracheal stenosis in children over two decades in a national cardiothoracic surgical unit. Cardiol Young 2020; 30:34-38. [PMID: 31744583 DOI: 10.1017/s1047951119002725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the outcomes of congenital tracheal stenosis among children. MATERIALS AND METHODS A retrospective review of all children who underwent surgical repair of congenital tracheal stenosis reviewing charts, operative notes, echocardiograms, CT and MRI data from January 2002 to February 2019. RESULTS Twenty-six children underwent surgical treatment for tracheal stenosis. The median age was 3 months (range 0.3-35 months) and the median weight was 4.7 kg (range 2.5-13 kg) at the time of surgical intervention. Stridor was the most common presenting symptom in 17 patients (65% of patients). Twenty-one patients (81%) had concurrent cardiac anomalies, with pulmonary arterial sling being the most common, present in nine patients (34%). Extracorporeal life support was utilised in seven patients (27%) pre-operatively. Laryngeal release was required in 16 patients. In 7 patients an end-to-end anastomosis was performed, in 18 patients slide tracheoplasty, and 1 patient had a double slide tracheoplasty. The median cardiopulmonary bypass time was 106 minutes (range 25-255 minutes). The median cross-clamp time was 30 minutes (range 5-67 minutes). The median post-operative duration of ventilation was 5 days (range 0.5-16 days). The median ICU length of stay was 12.5 days (range 2-60 days). There were three hospital mortalities with 88% survival. One patient only required reintervention with balloon dilation. Twenty-two patients (85%) remained symptom-free on median follow-up at 7.6 years (range 0.2-17 years). Two patients since 2017 had 3D printed tracheas produced from CT imaging to assist surgical planning. CONCLUSION Congenital tracheal stenosis can be managed effectively with excellent outcomes and 3D printed models assist in planning the optimal surgical intervention.
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Hobbs RD, Moon J, Murala J, Ohye RG. Novel Suture Technique for Slide Tracheoplasty for the Treatment of Long-Segment Tracheal Stenosis. Semin Thorac Cardiovasc Surg 2020; 32:930-934. [DOI: 10.1053/j.semtcvs.2019.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/13/2019] [Indexed: 11/11/2022]
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21
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Chan DS, Gabra N, Baig A, Manoukian JJ, Daniel SJ. Bridging the gap: Using 3D printed polycaprolactone implants to reconstruct circumferential tracheal defects in rabbits. Laryngoscope 2019; 130:E767-E772. [PMID: 31872882 DOI: 10.1002/lary.28472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/18/2019] [Accepted: 11/24/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE 1) To assess the feasibility of reconstructing 2-cm-long circumferential tracheal defects with a 3D printed polycaprolactone (PCL) implant in rabbits. 2) To evaluate endoscopic, histologic, and functional characteristics of a PCL tracheal implant over time. METHODS Ten New Zealand rabbits were included in this study. A 2-cm-long 3D printed PCL tracheal implant was created. All rabbits underwent surgical excision of a 2-cm-long cm segment of cervical trachea, which was reconstructed with the implant. Rabbits were sacrificed at the following time points: 0, 4, 5, 6, and 7 weeks postoperatively. At these time points, a rigid bronchoscopy was performed, and blinded evaluators calculated the percentage of airway stenosis. The tracheas were then harvested and prepared for histologic analysis. RESULTS All rabbits survived to their date of sacrifice except for one. Rabbits were euthanized between 0 to 54 days postoperatively with a median of 30 days. All rabbits developed significant granulation tissue with an average percentage stenosis of 92.3% ± 6.1%. On histology, granulation was present with extensive neovascularization and mixed inflammatory cells. There was re-epithelialization present on the luminal surface of the PCL implant near the anastomoses but absent at the center of the implant. CONCLUSION This study demonstrates that our 2-cm-long 3D printed PCL tracheal implant can be used to reconstruct a tracheal defect of equivalent size in a New Zealand rabbit model in the short term. However, significant granulation tissue formation limits long-term survival. Further research is warranted to limit the granulation tissue overgrowth. LEVEL OF EVIDENCE NA Laryngoscope, 2019.
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Affiliation(s)
- David S Chan
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nathalie Gabra
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Ayesha Baig
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - John J Manoukian
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Sam J Daniel
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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22
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Congenital diaphragmatic hernia and complete tracheal rings: The value of peri-operative ECMO. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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23
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Jing H, Zhang X, Gao M, Luo K, Fu W, Yin M, Wang W, Zhu Z, Zheng J, He X. Kartogenin preconditioning commits mesenchymal stem cells to a precartilaginous stage with enhanced chondrogenic potential by modulating JNK and β‐catenin–related pathways. FASEB J 2019; 33:5641-5653. [DOI: 10.1096/fj.201802137rrr] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Hui Jing
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Xiaoyang Zhang
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Manchen Gao
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Kai Luo
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Wei Fu
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Meng Yin
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Wei Wang
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Zhongqun Zhu
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Jinghao Zheng
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
| | - Xiaomin He
- Department of Cardiothoracic SurgeryShanghai Children's Medical CenterShanghai Jiao Tong University School of Medicine Shanghai China
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Galvez Alegria C, Gundogdu G, Yang X, Costa K, Mauney JR. Evaluation of Acellular Bilayer Silk Fibroin Grafts for Onlay Tracheoplasty in a Rat Defect Model. Otolaryngol Head Neck Surg 2018; 160:310-319. [PMID: 30274546 DOI: 10.1177/0194599818802267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the efficacy of acellular bilayer silk fibroin (BLSF) grafts to repair full-thickness tracheal defects and to compare the performance with conventional porcine small intestinal submucosa (SIS) implants. STUDY DESIGN A prospective controlled animal trial in a rat model of onlay tracheoplasty. SETTING Pediatric medical center. SUBJECTS AND METHODS Tracheal reconstruction of adult Sprague-Dawley rats was performed with BLSF (n = 38) or SIS (n = 32) matrices for up to 3 months of implantation. Functional evaluations of repaired conduits as well as histologic, immunohistochemical, and histomorphometric analyses of neotissues were assessed. RESULTS Prior to scheduled euthanasia, survival rates of rats receiving BLSF or SIS grafts were ≥94%, with no clinical signs of airway obstruction observed over the course of the study. Micro-computed tomography analysis revealed that the mean percentage of stenosis was <20% in both implant groups. BLSF and SIS grafts supported formation of pseudostratified ciliated columnar epithelium by 1 week postoperatively; however, each matrix failed to promote de novo chondrogenesis by 3 months following repair. CONCLUSIONS BLSF scaffolds can be used for reconstruction of rat tracheal patch defects with functional outcomes comparable to those of SIS matrices.
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Affiliation(s)
- Cinthia Galvez Alegria
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Gokhan Gundogdu
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Xuehui Yang
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle Costa
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua R Mauney
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Resheidat A, Kelly T, Mossad E. Incidental Diagnosis of Congenital Tracheal Stenosis in Children With Congenital Heart Disease Presenting for Cardiac Surgery. J Cardiothorac Vasc Anesth 2018; 33:781-784. [PMID: 29753667 DOI: 10.1053/j.jvca.2018.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ashraf Resheidat
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX
| | - Tamra Kelly
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX
| | - Emad Mossad
- Department of Pediatric Anesthesia, Baylor College of Medicine, Houston, TX.
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26
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Torre M. Left pulmonary artery sling and congenital tracheal stenosis: to slide or not to slide? J Thorac Dis 2018; 9:4881-4883. [PMID: 29312682 DOI: 10.21037/jtd.2017.11.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michele Torre
- Units of Pediatric Surgery and Airway Team, Istituto Giannina Gaslini, Genova, Italy
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