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Karkhanis T, Byju AG, Morales DL, Zafar F, Haridas B. Composite Biosynthetic Graft for Repair of Long-Segment Tracheal Stenosis: A Pilot In Vivo and In Vitro Feasibility Study. ASAIO J 2024; 70:527-534. [PMID: 38170278 PMCID: PMC11139240 DOI: 10.1097/mat.0000000000002130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Pediatric patients who undergo surgery for long-segment congenital tracheal stenosis (LSCTS) have suboptimal outcomes and postsurgical complications. To address this, we propose a biosynthetic graft comprising (1) a porcine small intestinal submucosa extracellular matrix (SIS-ECM) patch for tracheal repair, and (2) a resorbable polymeric exostent for biomechanical support. The SIS-ECM patch was evaluated in vivo in an ovine trachea model over an 8 month period. Concurrently, the biosynthetic graft was evaluated in a benchtop lamb trachea model for biomechanical stability. In vivo results show that SIS-ECM performs better than bovine pericardium (control) by preventing granulation tissue/restenosis, restoring tracheal architecture, blood vessels, matrix components, pseudostratified columnar and stratified epithelium, ciliary structures, mucin production, and goblet cells. In vitro tests show that the biosynthetic graft can provide the desired axial and flexural stability, and biomechanical function approaching that of native trachea. These results encourage future studies to evaluate safety and efficacy, including biomechanics and collapse risk, biodegradation, and in vivo response enabling a stable long-term tracheal repair option for pediatric patients with LSCTS and other tracheal defects.
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Affiliation(s)
- Teja Karkhanis
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | - Achu G. Byju
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | | | - Farhan Zafar
- Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Balakrishna Haridas
- From the Department of Biomedical Engineering, Texas A&M University, College Station, Texas
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Dai L, Zhao L, Shen L, Pan Z, Wu C, Mo L, Wu Y. Treatment of long-segment congenital tracheal stenosis with congenital cardiovascular defects in infancy. Int J Pediatr Otorhinolaryngol 2023; 172:111691. [PMID: 37536159 DOI: 10.1016/j.ijporl.2023.111691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES This study aims to evaluate the outcomes of simultaneous repair for infants with long-segment congenital tracheal stenosis (LSCTS) with congenital cardiovascular defects (CCD). METHODS We retrospectively reviewed the clinical data of infants aged less than 1 year with LSCTS and CCD who underwent simultaneous repair at Children's Hospital of Chongqing Medical University from January 2020 to March 2023. A systematic search of PubMed, Embase, and Cochrane Library for the relevant published studies that reported the simultaneous repair of CTS and CCD in infancy was conducted in March 2023. The inverse variance method of DerSimonian-Laird (D + L) was used for estimate synthesis. RESULTS A total of thirteen infants with a mean age of 5.6 ± 3.1 months and a mean weight of 6.4 ± 0.9 Kg underwent slide tracheoplasty with modified procedures and cardiovascular operations. LSCTS was diagnosed in all thirteen patients. Nine infants were ventilator dependent, and four patients were operated on due to persistent wheezing and recurrent respiratory infections. Seven patients underwent pulmonary artery sling repair, and six underwent atrial septal defect repair. All infants were repaired utilizing cardiopulmonary bypass (CPB) support. Significant complications were recorded in three patients. In-hospital deaths were seen in one case. The median tracheal minimum diameter of hospital survivors was significantly larger than the preoperative minimum diameter (p < 0.001). The mean follow-up duration was 17.1 ± 7.1 months. There was no late mortality during the follow-up. Twelve studies were included based on our search strategy. The pooled estimate of mortality in the literature was 10.9% (95%CI, 5.3%-17.7%, I2 = 0). The pooled estimate of airway re-interventions was 28.8% (95%CI, 14.5%-43.2%, I2 = 74%). CONCLUSIONS Simultaneous repair of LSCTS and CCD in infancy is safe and effective. Slide tracheoplasty with appropriate technical modifications may be valid for LSCTS repair without significant restenosis and reinterventions.
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Affiliation(s)
- Lurun Dai
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lu Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lianju Shen
- Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China
| | - Lin Mo
- Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China.
| | - Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China.
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3
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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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4
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Jin C, Lin N, Yang S, Yan C, Li S, Wu X, Zhu J. Postoperative nursing care of a child with pulmonary artery displacement combined with slide tracheobronchial plasty. Nurs Crit Care 2022; 28:446-453. [PMID: 35534433 DOI: 10.1111/nicc.12774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Generally, pulmonary artery sling operation involves the pulmonary artery transplantation to be cut off. Nursing care is focused on the postoperative pulmonary vascular anastomosis, respiratory tract, and blood pressure after surgery. We report the case of an infant who underwent pulmonary artery tracheal transposition combined with Slide keratoplasty, where the pulmonary artery transplantation was not cut off. We highlight that postoperative pulmonary artery blood flow to the unobstructed airway and airway reconstruction surgery should be focused on to help children recover and ensure successful surgery. METHODS To report the postoperative nursing experience of one patient with pulmonary artery sling undergoing pulmonary tracheal transposition combined with Slide arthroplasty. RESULTS Throughout the postoperative care, airway management should be focused on to maintain circulation stability in the early postoperative period, and corresponding measures such as posture management, atomization inhalation, and improved chest physical therapy should be applied according to the special surgical method of the case in order to reduce airway complications and to improve the surgical success rate of children with pulmonary artery sling undergoing pulmonary tracheal transposition combined with Slide arthroplasty. CONCLUSION In similar cases, after pulmonary tracheal transposition and Slide angioplasty, the doctors and nurses should pay attention to early circulation stability and focus on airway management through careful treatment and nursing, so as to promote the child's recovery.
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Affiliation(s)
- Chendi Jin
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Nan Lin
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shanfeng Yang
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chuanchuan Yan
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shuaini Li
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiujing Wu
- Cardiac Intensive Care Unit, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jihua Zhu
- Nursing Department, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Shen X, Tan W, Jia B, Ye M. Relationship between a Tracheal and Left Pulmonary Artery Stenosis Index and the Prognosis of Pulmonary Artery Sling with Tracheal Stenosis. Pediatr Cardiol 2021; 42:1585-1593. [PMID: 34046721 DOI: 10.1007/s00246-021-02643-9] [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: 06/19/2020] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
Pulmonary artery sling is a rare congenital pulmonary vascular malformation, often associated with tracheal or bronchial stenosis. Surgical treatment of pulmonary artery sling with tracheal stenosis (T) has a high risk of death and a relatively poor prognosis. This study explored the relationship between the T and left pulmonary artery stenosis (P) ratio and the effects of surgery for pulmonary artery sling with tracheal stenosis. Patients undergoing surgery for pulmonary artery sling in our center from January 2010 to December 2018 were retrospectively analyzed. Routine cardiac-enhanced computed tomography (CT) was performed preoperatively, and the P and T diameters were measured on the CT image. The T/P ratio was then calculated and analyzed. Thirty cases of pulmonary artery sling combined with tracheal stenosis were operated under cardiopulmonary bypass. The mean age at operation was 13.8 ± 13.6 months (1.2-57.1 months, Q1-Q3: 5-17 months), and the mean body weight was 8.8 ± 3.5 kg (3.8-17.3 kg, Q1-Q3: 5.8-11.5 kg). Twenty-three patients survived, and seven died, with an overall survival rate of 76.7%. Twenty-four patients underwent left pulmonary artery re-implantation, six patients underwent simultaneous left pulmonary artery re-implantation and slide tracheoplasty, and patients with intracardiac malformations (ventricular septal defect (n = 6) and atrial septal defect (n = 4)) underwent concurrent repair of the intracardiac defect. All cases had different degrees of tracheal stenosis, and the most narrowed trachea occurred with compression by the left pulmonary artery sling. The T/P ratio in the tracheoplasty group was significantly higher than that in the non-tracheoplasty group. The mortality rate in the T/P ≤ 1.15 group was significantly lower than that in the T/P > 1.15 group. Pulmonary artery sling treatment has a high risk of death. Left pulmonary artery re-implantation is an effective and safe surgical method for treating pulmonary artery sling, and slide tracheoplasty is an effective surgical method to correct tracheal stenosis. Children with T > 78.4% should receive active intervention for the tracheal stenosis, and these children have a considerable postoperative survival rate. The T/P ratio can be used to compare the relative superiority of the two compressions. A T/P ratio > 1.15 can be used as a reference index for intervention in tracheal stenosis and is a risk factor for postoperative death.
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Affiliation(s)
- Xiao Shen
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - WeiQiang Tan
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Bing Jia
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ming Ye
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
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Wu Y, Wang G, Dai J, Li H, Li Y, Wu C, Wei G. Slide Tracheoplasty for Congenital Tracheal Stenosis Repair: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:1532-1541. [PMID: 34287919 DOI: 10.1002/lary.29771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Congenital tracheal stenosis (CTS) is a rare but life-threatening condition in children. At present, slide tracheoplasty has been advocated as the preferred technique for most cases of CTS. However, the morbidity and mortality subsequent to slide tracheoplasty need further elaboration. Therefore, a meta-analysis was performed on the outcomes of slide tracheoplasty in children with CTS. STUDY DESIGN Systematic review and meta-analysis. METHODS Electronic databases, including PubMed, Embase, and Cochrane Library CENTRAL, were systematically searched for the period from January 1990 to March 2021 for literature that reported clinical outcomes of slide tracheoplasty for children with CTS. Meta-regression and subgroup analyses were performed to determine the risk factors for in-hospital mortality and airway reinterventions. RESULTS A total of 25 studies involving 577 patients were included. For children with CTS, in-hospital and overall mortality after slide tracheoplasty was 6.1% (95% CI = 4.2%-8.0%) and 9.7% (95% CI = 7.3%-12.1%), respectively. The incidence of airway reinterventions was 23.0% (95% CI = 15.6%-30.5%). The length of postoperative ventilation and hospital stay was 6.8 days (95% CI = 5.1-8.4 days) and 19.2 days (95% CI = 15.8-22.7 days), respectively. Postoperative complications occurred in 46.6% (95% CI = 35.8%-57.4%) of all patients. Meta-regression analysis showed that a higher proportion of the recently published studies reported significantly better in-hospital survival (coefficient -0.011, P = .021). CONCLUSIONS In conclusion, in-hospital mortality after slide tracheoplasty is 6.1%, and the incidence of airway reinterventions is 23.0%. In-hospital mortality after slide tracheoplasty has decreased chronologically. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Gang Wang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Guanghui Wei
- Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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7
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Smith MM, Kou YF, Schweiger C, Lehenbauer DG, de Alarcon A, Rutter MJ. Congenital Absence of Tracheal or Bronchial Rings. Otolaryngol Head Neck Surg 2020; 164:422-426. [PMID: 32838669 DOI: 10.1177/0194599820950725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Congenital airway stenosis secondary to absent tracheal or bronchial rings is a rare congenital anomaly that is difficult to manage both clinically and surgically. This typically manifests as severe segmental tracheomalacia, and only isolated cases with short-term follow-up have been previously described. We aim to describe a series of children with absent tracheal or bronchial rings who underwent surgical management and had long-term follow-up. STUDY DESIGN Case series with chart review. SETTING Tertiary care pediatric hospital. METHODS Patients with absent tracheal or bronchial rings from 2002 to 2016. Electronic and paper medical records were queried to obtain demographics, age at diagnosis and surgery, pre- and postoperative symptoms, location of absent rings, procedure performed, length of follow-up, and adjunctive procedures performed. RESULTS Nine subjects were identified who underwent slide tracheoplasty for correction of congenital absent tracheal or bronchial rings. Age at diagnosis ranged from 10 days to 5 years of age (median, 4 weeks). Age at surgery ranged from 3 weeks to 5 years of age (median, 5 weeks). Six out of 9 subjects were extubated on postoperative day 1. Only 1 subject required additional intervention, which included balloon dilation, tracheobronchial stenting, and aortopexy to alleviate the obstruction. Mean follow-up time was 5.89 years. CONCLUSIONS This is the largest series of children with absent tracheal rings who underwent slide tracheoplasty with long-term follow-up presented to date. Slide tracheoplasty is an effective surgical intervention for the treatment of absent tracheal or bronchial rings in infants and young children.
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Affiliation(s)
- Matthew M Smith
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yann-Fuu Kou
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Claudia Schweiger
- Department of Otolaryngology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - David G Lehenbauer
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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Yong MS, Konstantinov IE. Understanding the impact of slide tracheoplasty in congenital tracheal stenosis. Transl Pediatr 2019; 8:462-464. [PMID: 31993362 PMCID: PMC6970118 DOI: 10.21037/tp.2019.11.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Matthew S Yong
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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9
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Yong MS, Zhu MZL, Bell D, Alphonso N, Brink J, d'Udekem Y, Konstantinov IE. Long-term outcomes of surgery for pulmonary artery sling in children. Eur J Cardiothorac Surg 2019; 56:5305059. [PMID: 30715328 DOI: 10.1093/ejcts/ezz012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/06/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pulmonary artery (PA) sling is a rare vascular anomaly often associated with congenital tracheal stenosis. We describe the long-term outcomes with repair of this condition. METHODS A retrospective study was conducted at 2 institutions. From 1984 to 2018, 33 patients with PA sling underwent repair. RESULTS The median age at the time of surgery was 5.9 months (quartile 1-3: 2.5-12 months). Concomitant tracheal surgery was required in 21 patients (64%) where slide tracheoplasty was used in 11 patients (52%). There were no early deaths in patients who did not require tracheal surgery (n = 12). Operative mortality was 22% (2 of 9 patients) between 1984 and 1993, 11% (1 of 9 patients) between 1994 and 2003 and 6.7% (1 of 15 patients) between 2004 and 2018. The 15-year probability of survival for patients who had PA sling repair alone was 100%, and for patients who required PA sling and tracheal repair was 76 ± 10% (95% confidence interval 51-89%) (P = 0.08). The mean follow-up for survivors was 14 ± 9.8 years (3 months-33 years). All survivors were in the New York Heart Association functional class I/II at the last follow-up. Spirometry performed at a median age of 10.4 years after PA sling and tracheal surgery demonstrated obstructive lung defects with median forced expiratory volume in 1 s of 1.0 l (48% predicted), forced vital capacity of 1.5 l (74% predicted) and forced expiratory volume in 1 s/forced vital capacity of 0.69 (78% predicted). CONCLUSIONS Early mortality after PA sling repair is determined by the need for tracheal surgery. Though late survival was excellent, and the majority of survivors remained asymptomatic, long-term respiratory assessment and follow-up is warranted for these patients.
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Affiliation(s)
- Matthew S Yong
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael Z L Zhu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Douglas Bell
- Department of Cardiac Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - Nelson Alphonso
- Department of Cardiac Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - Johann Brink
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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10
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Yong MS, Harrison J, Berkowitz RG, Ranganathan S, Konstantinov IE. An approach to successful slide tracheoplasty in the low birth weight neonate with single lung. Int J Pediatr Otorhinolaryngol 2018; 108:80-81. [PMID: 29605371 DOI: 10.1016/j.ijporl.2018.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/04/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
The advent of the slide tracheoplasty technique and a multi-disciplinary approach has improved outcomes of congenital tracheal stenosis. However, tracheal surgery in younger patients with pulmonary malformations, especially low birth-weight neonates, has been associated with increased mortality. Patients with very low birth-weight, pulmonary malformations and prematurity may be palliated prior to definitive tracheal surgery due to the poor prognosis. We report a successful and unique approach of delaying tracheal reconstruction to allow growth and development in the premature, very low birth-weight neonate (1046g) with left lung agenesis.
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Affiliation(s)
- Matthew S Yong
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Australia; University of Melbourne, Australia; Murdoch Children's Research Institute, Australia
| | - Joanne Harrison
- University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Department of Respiratory Medicine, Royal Children's Hospital, Australia
| | - Robert G Berkowitz
- University of Melbourne, Australia; Department of Otolaryngology, Royal Children's Hospital, Australia
| | - Sarath Ranganathan
- University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Department of Respiratory Medicine, Royal Children's Hospital, Australia
| | - Igor E Konstantinov
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Australia; University of Melbourne, Australia; Murdoch Children's Research Institute, Australia.
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11
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Zhang H, Wang S, Lu Z, Zhu L, Du X, Wang H, Xu Z. Slide tracheoplasty in 81 children: Improved outcomes with modified surgical technique and optimal surgical age. Medicine (Baltimore) 2017; 96:e8013. [PMID: 28930836 PMCID: PMC5617703 DOI: 10.1097/md.0000000000008013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the surgical outcome of slide tracheoplasty.Eighty-one patients who underwent slide tracheoplasty were retrospectively reviewed. Before and after operation, all patients were examined by computed tomography (CT) and bronchoscopy regularly.There were 8 deaths and the mortality was 9.9%. They all died of respiratory failure associated with the formation of granulation tissue in the airway postoperatively. The mortality was 15.8% from 2009 to 2012 and decreased to 8.1% from 2013 to 2016. The mortality of patients aged 10 to 24 months was 5.7%, which was significantly lower than those younger than 10 months and those older than 24 months. After surgery, 11 patients had granulation tissue growing at anastomosis edges and 8 of them died eventually. Twenty patients had mucosa varus at the site of anastomosis which mainly happened in the early time. Between different time periods and different age groups, there was significant difference in the incidence of granulation tissue and mucosa varus (P < .01). Clinical symptoms of tracheal stenosis disappeared and the results of CT were satisfactory after operation.Slide tracheoplasty is an effective surgical method for congenital tracheal stenosis associated with congenital heart disease. With the continuous improvement of surgical technique, the mortality has been reduced and the incidence of granulation tissue and mucosa varus also has been reduced. The period of 10 to 24 months of age is the optimal cure time.
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