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Menna C, Fiorelli S, Marinucci BT, Massullo D, D'Andrilli A, Ciccone AM, Andreetti C, Maurizi G, Vanni C, Siciliani A, Tiracorrendo M, Mancini M, Venuta F, Rendina EA, Ibrahim M. New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00282-4. [PMID: 38555996 DOI: 10.1016/j.jtcvs.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients. METHODS It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post-COVID-19 patients and 123 were in non-COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post-COVID-19 group and a non-COVID group. RESULTS No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post-COVID-19 patients (n = 20 in the post-COVID-19 group vs n = 11 in the non-COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post-COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post-COVID-19 group versus 4 (16%) patients in the non-COVID-19 group (P = .03). CONCLUSIONS Tracheal resection continues to be safe and effective in COVID-19-related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared with non-COVID-19 patients.
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Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Silvia Fiorelli
- Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Domenico Massullo
- Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Vanni
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandra Siciliani
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Tiracorrendo
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mancini
- Morphologic and Molecular Pathology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Parshin VD, Porkhanov VA, Polyakov IS, Kovalenko AL, Zhikharev VA, Parshin AV, Rusakov MA, Parshin VV. [Improving surgical technique for tracheal resection with anastomosis]. Khirurgiia (Mosk) 2024:6-20. [PMID: 38258683 DOI: 10.17116/hirurgia20240116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To present modern aspects of improving surgical techniques in tracheal resection developed in recent years. MATERIAL AND METHODS The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described. CONCLUSION Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.
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Affiliation(s)
- V D Parshin
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Moscow, Russia
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - V A Porkhanov
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - I S Polyakov
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A L Kovalenko
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - V A Zhikharev
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Marziali V, Mangiameli G, Crepaldi A, Piccioni F, Costantini E, Citterio E, Borbone A, Cariboni U. Right tracheal sleeve pneumonectomy with VV-ECMO assistance for non-small cell lung cancer through anterior thoracotomy: a single centre experience. Front Surg 2023; 10:1238462. [PMID: 37601529 PMCID: PMC10435269 DOI: 10.3389/fsurg.2023.1238462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
For a long time, non-small cell lung cancer (NSCLC) arising less than 2 cm distal to the carina has been usually considered unresectable and incurable with a radical or extended resection because of surgical technical difficulty and airway management. Recently, the introduction of more advanced surgical techniques, often including the use of extracorporeal life support (ECLS), has allowed us to extend the limits of conventional surgery, increasing the rate of complete surgical resection. ECLS also overcomes the limitation of conventional ventilation during complex tracheo-bronchial reconstruction, avoiding the presence of disturbing lines or tubes that obstruct the operative field during a challenging surgery. In this article, we share our experience in performing right tracheal sleeve pneumonectomy with veno-venous extracorporeal membrane oxygenation (VV-ECMO) in three cases by anterior right thoracotomy, reporting our tips and tricks.
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Affiliation(s)
- Valentina Marziali
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Federico Piccioni
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Costantini
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Enrico Citterio
- Department of Cardiac Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessandro Borbone
- Department of Cardiac Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
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Slama A, Stork T, Collaud S, Aigner C. Current use of extracorporeal life support in airway surgery: a narrative review. J Thorac Dis 2023; 15:4101-4110. [PMID: 37559597 PMCID: PMC10407487 DOI: 10.21037/jtd-22-1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Extracorporeal life support (ECLS) is widely used in patients with severe respiratory or cardiocirculatory failure. The most commonly used extracorporeal membrane oxygenation (ECMO) modes are veno-venous (V-V) and veno-arterial (V-A) ECMO, which can both be achieved by various types of vascular cannulation. Within the scope of tracheobronchial surgery, intraoperative ECLS may occasionally be necessary to provide sufficient oxygenation to a patient throughout a procedure, especially when conventional ventilation strategies are limited. Additionally, V-A ECMO can provide cardiopulmonary support in emergencies and in cases where hemodynamic instability can occur. METHODS This narrative literature review was carried out to identify the use and the specifics of ECLS in airway surgery over the last years. Data from 168 cases were summarized according to the indication for surgery and the mode of ECLS (V-V, V-A). KEY CONTENT AND FINDINGS The most common tracheobronchial pathologies in which support was needed were: primary malignant disease of the airways, malignant infiltration, tracheal stenosis, injury of the airway, and congenital airway disease. With increasing experience in ECLS, the number of reported cases performed with intraoperative ECLS increased steadily over the last decade. CONCLUSIONS A trend favoring the use of V-V ECMO over V-A ECMO was identified. These approaches should now be considered indispensable tools for managing challenging surgical cases.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
- Department of Thoracic Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
- Department of Thoracic Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Stephane Collaud
- Department of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
- Department of Thoracic Surgery, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University Medicine Essen, Ruhrlandklinik, Essen, Germany
- Department of Thoracic Surgery, Klinik Floridsdorf, Vienna, Austria
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Mangiameli G, Perroni G, Costantino A, De Virgilio A, Malvezzi L, Mercante G, Giudici VM, Ferraroli GM, Voulaz E, Giannitto C, Acocella F, Onorati I, Martinod E, Cariboni U. Analysis of Risk Factors for Tracheal Stenosis Managed during COVID-19 Pandemic: A Retrospective, Case-Control Study from Two European Referral Centre. J Pers Med 2023; 13:jpm13050729. [PMID: 37240899 DOI: 10.3390/jpm13050729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/08/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Benign subglottic/tracheal stenosis (SG/TS) is a life-threatening condition commonly caused by prolonged endotracheal intubation or tracheostomy. Invasive mechanical ventilation was frequently used to manage severe COVID-19, resulting in an increased number of patients with various degrees of residual stenosis following respiratory weaning. The aim of this study was to compare demographics, radiological characteristics, and surgical outcomes between COVID-19 and non-COVID patients treated for tracheal stenosis and investigate the potential differences between the groups. MATERIALS AND METHODS We retrospectively retrieved electronical medical records of patients managed at two referral centers for airways diseases (IRCCS Humanitas Research Hospital and Avicenne Hospital) with tracheal stenosis between March 2020 and May 2022 and grouped according to SAR-CoV-2 infection status. All patients underwent a radiological and endoscopic evaluation followed by multidisciplinary team consultation. Follow-up was performed through quarterly outpatient consultation. Clinical findings and outcomes were analyzed by using SPPS software. A significance level of 5% (p < 0.05) was adopted for comparisons. RESULTS A total of 59 patients with a mean age of 56.4 (±13.4) years were surgically managed. Tracheal stenosis was COVID related in 36 (61%) patients. Obesity was frequent in the COVID-19 group (29.7 ± 5.4 vs. 26.9 ± 3, p = 0.043) while no difference was found regarding age, sex, number, and types of comorbidities between the two groups. In the COVID-19 group, orotracheal intubation lasted longer (17.7 ± 14.5 vs. 9.7 ± 5.8 days, p = 0.001), tracheotomy (80%, p = 0.003) as well as re-tracheotomy (6% of cases, p = 0.025) were more frequent and tracheotomy maintenance was longer (21.5 ± 11.9 days, p = 0.006) when compared to the non-COVID group. COVID-19 stenosis was located more distal from vocal folds (3.0 ± 1.86 vs. 1.8 ± 2.03 cm) yet without evidence of a difference (p = 0.07). The number of tracheal rings involved was lower in the non-COVID group (1.7 ± 1 vs. 2.6 ± 0.8 p = 0.001) and stenosis were more frequently managed by rigid bronchoscopy (74% vs. 47%, p = 0.04) when compared to the COVID-19 group. Finally, no difference in recurrence rate was detected between the groups (35% vs. 15%, p = 0.18). CONCLUSIONS Obesity, a longer time of intubation, tracheostomy, re-tracheostomy, and longer decannulation time occurred more frequently in COVID-related tracheal stenosis. These events may explain the higher number of tracheal rings involved, although we cannot exclude the direct role of SARS-CoV-2 infection in the genesis of tracheal stenosis. Further studies with in vitro/in vivo models will be helpful to better understand the role of inflammatory status caused by SARS-CoV-2 in upper airways.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Gianluca Perroni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Luca Malvezzi
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Giorgio Maria Ferraroli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Caterina Giannitto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Fabio Acocella
- Department of Veterinary Medicine and Animal Science, University of Milan, Via dell'Università 6, 26900 Lodi, LO, Italy
| | - Ilaria Onorati
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, 93000 Paris, France
| | - Emmanuel Martinod
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, 93000 Paris, France
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
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Passera E, Orlandi R, Calderoni M, Cassina EM, Cioffi U, Guttadauro A, Libretti L, Pirondini E, Rimessi A, Tuoro A, Raveglia F. Post-intubation iatrogenic tracheobronchial injuries: The state of art. Front Surg 2023; 10:1125997. [PMID: 36860949 PMCID: PMC9968843 DOI: 10.3389/fsurg.2023.1125997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
Iatrogenic tracheobronchial injury (ITI) is an infrequent but potentially life-threatening disease, with significant morbidity and mortality rates. Its incidence is presumably underestimated since several cases are underrecognized and underreported. Causes of ITI include endotracheal intubation (EI) or percutaneous tracheostomy (PT). Most frequent clinical manifestations are subcutaneous emphysema, pneumomediastinum and unilateral or bilateral pneumothorax, even if occasionally ITI can occur without significant symptoms. Diagnosis mainly relies on clinical suspicion and CT scan, although flexible bronchoscopy remains the gold standard, allowing to identify location and size of the injury. EI and PT related ITIs more commonly consist of longitudinal tear involving the pars membranacea. Based on the depth of tracheal wall injury, Cardillo and colleagues proposed a morphologic classification of ITIs, attempting to standardize their management. Nevertheless, in literature there are no unambiguous guidelines on the best therapeutic modality: management and its timing remain controversial. Historically, surgical repair was considered the gold standard, mainly in high-grade lesions (IIIa-IIIb), carrying high morbi-mortality rates, but currently the development of promising endoscopic techniques through rigid bronchoscopy and stenting could allow for bridge treatment, delaying surgical approach after improving general conditions of the patient, or even for definitive repair, ensuring lower morbi-mortality rates especially in high-risk surgical candidates. Our perspective review will cover all the above issues, aiming at providing an updated and clear diagnostic-therapeutic pathway protocol, which could be applied in case of unexpected ITI.
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Affiliation(s)
- Eliseo Passera
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy,Correspondence: Eliseo Passera Riccardo Orlandi
| | - Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy,Correspondence: Eliseo Passera Riccardo Orlandi
| | - Matteo Calderoni
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Emanuele Pirondini
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Antonio Tuoro
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
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Rorris FP, Chatzimichali E, Liverakou E, Antonopoulos CN, Balis E, Kotsifas C, Stratakos G, Koutsoukou A, Zisis C. Tracheal resection in post COVID-19 patients is associated with high reintervention rate and early restenosis. JTCVS Tech 2023; 18:157-163. [PMID: 36685052 PMCID: PMC9846877 DOI: 10.1016/j.xjtc.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/21/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives A remarkable increase in the number of patients presenting with tracheal complications after prolonged endotracheal intubation and mechanical ventilation for the management of the severe COVID-19 - associated respiratory failure has been observed. In this study, we assessed the postoperative outcomes of tracheal resection in COVID-19 patients. Methods We conducted a retrospective study in which all patients with a history of prolonged invasive mechanical ventilation due to COVID-19 infection, who were treated with tracheal resection and reconstruction, were included. The primary objective was in-hospital mortality and postoperative reintervention rate. The secondary objective was the time to tracheal restenosis. Results During the 16-month study period, 11 COVID-19 patients with tracheal complications underwent tracheal resection with end-to-end anastomosis. Mean patient age was 51.5 ± 9 years, and the majority were male (9 patients). Eight patients were referred for management of post-intubation tracheal stenosis and 3 for tracheoesophageal fistula. Eight patients had a history of tracheostomy during the COVID-19 infection hospitalization. There was one in-hospital death (9.1%) due to septicemia in the Intensive Care Unit, approximately two months after the operation. Postoperatively, 32 reinterventions were required for tracheal restenosis due to granulation tissue formation. The risk for reintervention was higher during the first 3 months after the index operation. Four patients developed tracheal restenosis (36.4%) and two of them required endotracheal stent placement during the follow up period. Conclusions Tracheal resection and reconstruction after COVID-19 infection is associated with a high reintervention rate postoperatively. Such patients require close follow up in expert interventional pulmonology units and physicians should be on high alert for the early diagnosis and optimal management of tracheal restenosis.
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Affiliation(s)
- Filippos-Paschalis Rorris
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece,Address for reprints: Filippos-Paschalis Rorris, MD, Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Ypsilantou 45-47, Athens, 106 76, Greece
| | - Evangelia Chatzimichali
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Evangelia Liverakou
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Constantine N. Antonopoulos
- Department of Vascular Surgery, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Balis
- Department of Interventional Pulmonology, Evangelismos General Hospital, Athens, Greece
| | - Constantinos Kotsifas
- Department of Interventional Pulmonology, Evangelismos General Hospital, Athens, Greece
| | - Grigoris Stratakos
- Department of Interventional Pulmonology, 1st Department of Pulmonology, Medical School, University of Athens, “Sotiria” Hospital, Athens, Greece
| | - Antonia Koutsoukou
- Department of Interventional Pulmonology, 1st Department of Pulmonology, Medical School, University of Athens, “Sotiria” Hospital, Athens, Greece
| | - Charalampos Zisis
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
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Kramer LM, Walton KL. Survey of current trends in the management of traumatic subcutaneous emphysema in dogs. J Vet Emerg Crit Care (San Antonio) 2022; 32:549-554. [PMID: 35001489 DOI: 10.1111/vec.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Subcutaneous emphysema (SCE) is a common occurrence in emergency veterinary practice, but published information regarding treatment and management strategies is lacking. This study examined trends in diagnostic and treatment recommendations. STUDY DESIGN An internet-based survey with cross-sectional analysis. There were 129 respondents: board-certified and nonboard-certified veterinarians in private practice and university settings. KEY FINDINGS Significant differences in the choice of diagnostics and treatment were found based on the etiology and severity of SCE and between respondent groups. Computed tomography (CT) was selected more frequently for SCE resulting from blunt or penetrating traumas by the board-certified veterinarians practicing in a teaching hospital (VTH group; P < 0.001). All veterinarians were more likely to select tracheobronchoscopy as part of their workup for SCE as a result of endotracheal intubation trauma (P = 0.0093 [penetrating traumas]; P = 0.0002 [blunt force traumas]). Intermittent SC drainage and ventral cervical exploratory surgery were more likely to be chosen as treatments when SCE was classified as severe generalized (P < 0.0001). SIGNIFICANCE There is significant variation in the treatment of SCE in veterinary medicine as well as associated diagnostics to determine severity and treatment options. Further studies are indicated to determine the optimal approach and provide guidance to clinicians.
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Affiliation(s)
- Leah M Kramer
- Cape Cod Veterinary Specialists, Buzzards Bay, Massachusetts, USA
| | - Karie L Walton
- Cape Cod Veterinary Specialists, Buzzards Bay, Massachusetts, USA
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Carlson L, Haider M, Liu H, Baird C, Mayer JE, Nathan M. Left Pulmonary Artery Sling: Postoperative Outcomes for Patients at a Single Center. World J Pediatr Congenit Heart Surg 2021; 12:715-727. [PMID: 34846972 DOI: 10.1177/21501351211040741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Left pulmonary artery (LPA) sling is a rare anomaly characterized by the origin of the LPA from the right pulmonary artery with a course between the trachea and esophagus. It is often associated with airway and cardiac anomalies. METHODS This is a retrospective case series of consecutive patients who underwent LPA sling repair (LPASR) at a tertiary care center over a 35-year period with a focus on tracheal and/or LPA reinterventions and survival. RESULTS Between June 1983 and July 2018, 42 patients were identified: isolated LPASR was performed in 16 (38%), LPASR/intracardiac repair in 10 (24%), and LPASR/tracheal repair in 16 (38%). There were 5 (12%) in-hospital and 4 (10%) late deaths. Survival rates (15 years) were as follows: 100% (isolated LPASR), 65% (concomitant intracardiac repair), and 52% (concomitant tracheal surgery). Preoperative intensive care unit (ICU) hospitalization was associated with future intervention on the LPA/trachea (61%, 11/18). The median distribution of blood flow to the left lung post-index surgery was 38%. Freedom from isolated LPA intervention was 100% after isolated LPASR, 93% after LPASR/tracheal surgery, and 69% after LPASR/intracardiac repair. Freedom from isolated tracheal intervention was 92% after isolated LPASR, 73% after LPASR/tracheal surgery, and 78% after LPASR/intracardiac repair. CONCLUSIONS ICU hospitalization prior to index surgery may indicate the severity of associated cardiac/tracheal abnormalities as this is associated with increased morbidity and mortality. Patients who underwent LPASR/intracardiac surgery were more likely to undergo isolated LPA intervention and those who underwent LPASR/tracheal surgery were more likely to undergo isolated tracheal intervention.
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Affiliation(s)
| | - Mahwish Haider
- 1862Boston Children's Hospital.,522567Amsterdam University Medical Centre
| | - Hua Liu
- 1862Boston Children's Hospital
| | - Christopher Baird
- 1862Boston Children's Hospital.,1811Harvard Medical School, Boston, MA
| | - John E Mayer
- 1862Boston Children's Hospital.,1811Harvard Medical School, Boston, MA
| | - Meena Nathan
- 1862Boston Children's Hospital.,1811Harvard Medical School, Boston, MA
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10
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Riggs KW, Wells D, Zafar F, Morales DLS, Bryant R, Tweddell JS. Risk of Pediatric Cardiac Surgery Increased in Patients Undergoing Tracheal Surgery During the Same Hospitalization. World J Pediatr Congenit Heart Surg 2021; 12:730-736. [PMID: 34424089 DOI: 10.1177/21501351211037624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of complex tracheal surgery (TS) on outcomes of children undergoing cardiac surgery has rarely been investigated in large national databases and could impact anticipated outcomes in those patients. METHODS The Pediatric Health Information System database was reviewed from January 1, 2005 to December 31, 2014, for pediatric (<18 years) patients undergoing select cardiac surgical procedures using International Classification of Disease-9 procedural coding. Patients were divided based upon having TS (excluding tracheostomy) during the same hospitalization. Patients with tracheal and cardiac surgeries (CHS + TS) were propensity matched in a 1 : 2 fashion to patients undergoing isolated cardiac surgeries without TS (CHS) based upon cardiac procedure(s), age at surgery, gender, and discharge year. Hospital mortality and other outcomes were compared between the 2 matched groups. RESULTS The 283 CHS + TS patients were similar to the 566 CHS patients in gender, race, age, cardiac procedures, and presence of chromosomal abnormalities, all P > .05. Hospital mortality was 13.8% (n = 39) for CHS + TS and 5.8% (n = 33) for CHS patients with an unadjusted 2.58 hazard ratio of death (95% confidence interval: 1.59-4.20; P < .001). CHS + TS was also associated with a greater length of stay (63 days vs 12 days), a higher cost per hospitalization ($322 402 vs $80 273), and more readmissions (64.3% [n = 182] vs 41.8% [n = 243]), all P < .001. CONCLUSIONS Patients undergoing cardiac and TS in the same hospitalization are at greater risk of in-hospital mortality than patients undergoing similar cardiac surgeries alone and incur higher resource utilization thereafter. The increased risk of mortality is currently underappreciated, but it is important to recognize when discussing expectations with families and providers.
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Affiliation(s)
- Kyle W Riggs
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Northwell Health, Manhasset, NY, USA
| | - Dennis Wells
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - Farhan Zafar
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - David L S Morales
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | | | - James S Tweddell
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
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11
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Abstract
Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.
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Affiliation(s)
- A V Starostin
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - Z G Berikkhanov
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - D M Amangeldiev
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
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12
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Herrmann D, Volmerig J, Al-Turki A, Braun M, Herrmann A, Ewig S, Hecker E. Does less surgical trauma result in better outcome in management of iatrogenic tracheobronchial laceration? J Thorac Dis 2019; 11:4772-4781. [PMID: 31903267 DOI: 10.21037/jtd.2019.10.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Iatrogenic tracheobronchial injury is a rare, but severe complication of endotracheal intubation. Risk factors are emergency intubation, percutaneous dilatational tracheostomy and intubation with double lumen tube. Regarding these procedures, underlying patients often suffer from severe comorbidities. The aim of this study was to evaluate the results of a standardized treatment algorithm in a referral center with focus on the surgical approach. Methods Sixty-four patients with iatrogenic tracheal lesion were treated in our department by standardized management adopted to clinical findings between 2003 and 2019. Patients with superficial laceration were treated conservatively. In the case of transmural injury of the tracheal wall and necessity of mechanical ventilation, patients underwent surgery. We decided on a cervical surgical approach for lesions limited to the trachea. In case of involvement of a main bronchus we performed thoracotomy. Data were evaluated retrospectively. Results In 19 patients the tracheal lesion occurred in elective intubation and in 17 patients during emergency intubation. In 23 cases a tracheal tear occurred during percutaneous dilatational tracheostomy and in three patients at replacement of a tracheostomy tube. Two patients received laceration during bronchoscopy. Twenty-nine patients underwent surgery with cervical approach and 14 underwent thoracotomy. There was no difference in the mortality of these groups. Treatment of tracheal tear was successful in 62 individuals. Nine patients died of multi organ dysfunction syndrome (MODS), two of them during surgery. Conclusions Iatrogenic tracheal laceration is a life-threatening complication and the mortality after tracheal injury is high, even in a specialized thoracic unit. Conservative management in patients with superficial tracheal lesion is a feasible procedure. In case of complete laceration of tracheal wall, surgical therapy is recommendable, whereby several approaches of surgical management seem to be equivalent.
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Affiliation(s)
- Dominik Herrmann
- Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany
| | - Jan Volmerig
- Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany
| | - Ahmad Al-Turki
- Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany
| | - Monique Braun
- Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany
| | - Anke Herrmann
- Institute of Virology, University of Duisburg-Essen, Essen, Germany
| | - Santiago Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, Evangelisches Krankenhaus, Herne, Germany
| | - Erich Hecker
- Thoraxzentrum Ruhrgebiet, Department of Thoracic Surgery, Evangelisches Krankenhaus, Herne, Germany
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13
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Timman ST, Schoemaker C, Li WWL, Marres HAM, Honings J, Morshuis WJ, van der Heijden EHFM, Verhagen AFTM. Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis. Ann Cardiothorac Surg 2018; 7:227-236. [PMID: 29707500 DOI: 10.21037/acs.2018.03.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background In this study we focus on functional outcomes after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis, with a specific interest in the impact of laryngeal involvement on postoperative outcome. Methods All patients who underwent (laryngo)tracheal surgery for benign pathology between 1996 and 2017 in our centre were included in this retrospective study. Surgical outcomes were procedural success rate, and airway- and voice-related complications. Functional results were assessed using (standardized) questionnaires for quality of life, sensation of dyspnea, swallowing function, and voice perception. Results Of 119 consecutive patients, 47 underwent laryngotracheal resection and reconstruction and 72 underwent segmental tracheal surgery (78% with an end-to-end tracheal anastomosis and 22% with a cricotracheal anastomosis). Overall success rate was 92% and was similar for all groups, with an overall significant improvement in quality of life when compared to the preoperative situation. However, after laryngotracheal surgery, airway-related complications were more common when compared to segmental resections with an end-to-end tracheal anastomosis (30% versus 7%, P=0.003). Additionally, early voice alterations without recurrent nerve palsy were reported twice as often (34% versus 16%, P=0.034) and voice quality experienced during follow-up was significantly worse when compared to segmental resections. Overall response rate to the questionnaires on functional outcome was 63%. Conclusions (Laryngo)tracheal surgery is safe and beneficial, with significant functional improvement during mid- and long-term follow-up. However, laryngeal involvement is a predictor for increased surgical airway-related complications. Additionally, voice alterations without recurrent nerve palsy are far more common after laryngotracheal resection and are a serious handicap. This aspect is underexposed in current literature and deserves further attention during preoperative counseling and patient follow-up. However, the results on functional outcome of this current study should be interpreted with caution due to the somewhat low response rate of the questionnaires.
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Affiliation(s)
- Simone T Timman
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christiana Schoemaker
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wilson W L Li
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henri A M Marres
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jimmie Honings
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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14
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Abstract
Tracheobronchomalacia is an uncommon acquired disorder of the central airways. Common symptoms include dyspnea, constant coughing, inability to raise secretions and recurrent respiratory infections. Evaluation includes an inspiratory-expiratory chest computed tomography (dynamic CT), an awake functional bronchoscopy and pulmonary function studies. Patients with significant associated symptoms and severe collapse on CT and bronchoscopy are offered membraneous wall plication. Tracheobronchoplasty is performed through a right thoracotomy. The posterior airway is exposed after the azygous vein is ligated. The posterior wall of the trachea (and usually both main bronchi) is plicated to a sheet of thick acellular dermis (or polypropylene mesh) with a series of 4 mattress sutures of 4-0 sutures from the thoracic inlet to the bottom of the trachea to re-shape the trachea and restore the normal D shape. Patients report generally good results with improvement of their symptoms. Quality of life is usually improved while pulmonary function tests usually are not improved.
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Affiliation(s)
- Cameron D Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
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15
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Erhan B, Kemerdere R, Kizilkilic O, Gunduz B, Hanci M. Acute tetraplegia following laryngotracheal reconstruction surgery. Surg Neurol Int 2018; 9:11. [PMID: 29416908 PMCID: PMC5791509 DOI: 10.4103/sni.sni_405_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/24/2017] [Indexed: 11/04/2022] Open
Abstract
Background Paraplegia following thoracic spinal surgery or abdominal operations is usually attributed to spinal cord ischemia due to interruption of the segmental spinal vascular supply. Alternatively, the etiology of spinal cord ischemia following cervical surgery is less clear. Case Description A 14-year-old male became acutely tetraplegic with a C4 sensory level and sphincteric dysfunction 12 h following surgery for tracheal stenosis due to prior intubation. Signs included loss of pain and temperature below the level of C4 with preservation of deep sensations (position and vibration) and mute plantar responses. The cervical magnetic resonance imaging revealed diffuse intramedullary cord swelling between C2-C7 and hyperintense signal changes in the anterior and posterior columns of the cord on T2-weighted images. Various etiologies for this finding included a cervical hyperextension or hyperflexion injury vs. anterior spinal artery syndrome. Conclusions Postoperative treatment of spinal cord ischemia attributed to cervical and thoracoabdominal surgery is largely ineffective in reversing major neurological deficits. Therefore, it is critical to prevent ischemia during these procedures by the avoidance of coagulopathies, anemia, hypotension, and hyperflexion/hyperextension maneuvers.
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Affiliation(s)
- Belgin Erhan
- Department of Physical Medicine and Rehabilitation, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Rahsan Kemerdere
- Department of Neurosurgery, Subdivision of Neuroradiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Subdivision of Neuroradiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Berrin Gunduz
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Murat Hanci
- Department of Neurosurgery, Subdivision of Neuroradiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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16
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Conforti A, Valfrè L, Scuglia M, Trozzi M, Meucci D, Sgrò S, Bottero S, Bagolan P. Laryngotracheal Abnormalities in Esophageal Atresia Patients: A Hidden Entity. Front Pediatr 2018; 6:401. [PMID: 30619795 PMCID: PMC6305472 DOI: 10.3389/fped.2018.00401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/04/2018] [Indexed: 11/23/2022] Open
Abstract
Importance: Presence of laryngotracheal abnormalities is associated with increased morbidity and higher mortality rate in esophageal atresia patients. Objective: Determine the prevalence of laryngotracheal abnormalities (LTA) in a prospectively collected cohort of patients treated for esophageal atresia and/or tracheoesophageal fistula (EA/TEF). Analysis of the impact of those airway anomalies in early post-operative outcomes was performed. Patients and Methods: This was a review of a prospectively collected database, including patients from January 2008 to December 2017. Patients enrolled in the present study were treated in a high-volume referral center. Present study included all newborn-infants consecutively treated for EA/TEF. All patients were evaluated by flexible laryngotracheoscopy performed under local anesthesia in spontaneous breathing. In case of airway malformation suspected during flexible endoscopy, a rigid endoscopy was performed to complete airway assessment. If post-operative respiratory symptoms (noisy breathing, respiratory difficulty, failure to extubate, or difficulty feeding) were noted, a second laryngotracheoscopy was performed. Primary study outcome was to evaluate the prevalence of LTA in EA/TEF infants, characterizing of LTA, and their impact on early post-operative outcomes. Those primary study outcomes were planned before data collection began. Results: During the study period 207 patients with EA/TEF were treated. LTA had a period prevalence of 40.1% (83/207). Although no differences were recorded in terms of demographics and clinical presentation, LTA+ infants more frequently required tracheostomy (12/52, 23% vs. 0/124, 0%; p 0.0001) and were at increased risk of death (12/83, 14% vs. 5/124, 4%; p 0.009) in comparison with EA/TEF without LTA. Conclusions: Present data suggest a high prevalence of congenital LTA in patients affected by EA. Most of the abnormalities are congenital and a high proportion of patients with LTA require a tracheostomy. Mortality significantly correlates with the presence of LTA. Systematic airway endoscopic preoperative evaluation has to be pushed forward to minimize LTA-related morbidity and mortality.
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Affiliation(s)
- Andrea Conforti
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Laura Valfrè
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marianna Scuglia
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marilena Trozzi
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Duino Meucci
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefania Sgrò
- Anesthesiology Unit, Department of Anesthesiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sergio Bottero
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
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17
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Abstract
AIM To analyze long-term outcomes of tracheal transplantation. MATERIAL AND METHODS There were 1128 patients with cicatricial tracheal stenosis who have been operated at the Petrovsky Russian Research Center for Surgery and the Sechenov First Moscow State Medical University for the period 1963-2015. RESULTS Operations have become safer. Postoperative morbidity and mortality reduced from 41.4% (1963-1980) to 5.6% (2001-2015) and from 21.9% (1963-1980) to 0.5% (2001-2015), respectively. Tracheal transplantation was performed in 2 cases and fundamentally different tracheal structures were applied. Donor thyreotracheal complex with restored blood supply through thyroid vessels was used in the first case (2006). Perennial experimental trials preceded clinical application of this technique. In the second case (2010) we applied scientific results of foreign colleagues (cellular technologies and methods of regenerative medicine to create artificial trachea). Patients are still alive after 12 and 8 years, respectively. Restoration of blood supply of donor trachea is possible through thyroid collaterals. This technique is successful in long-term period. Tissue-engineered trachea cannot be considered true trachea due to no all tracheal components. However, such trachea provides air-conducting, evacuation and protective functions. Tracheomalacia requires further researches as one of the main problems of tracheal transplantation.
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Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Lyundup
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E A Tarabrin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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18
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Ulusan A, Sanli M, Isik AF, Celik İA, Tuncozgur B, Elbeyli L. Surgical treatment of postintubation tracheal stenosis: A retrospective 22-patient series from a single center. Asian J Surg 2017; 41:356-362. [PMID: 28412038 DOI: 10.1016/j.asjsur.2017.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE We aimed to present cases of postintubation tracheal stenosis (PITS), all due to long-term intubation and treated surgically in a university hospital, and to discuss them in light of the literature. METHODS In this retrospective study, 22 patients who were treated with tracheal resection and reconstruction due to PITS were included. Demographics, intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. RESULTS The mean intubation duration was 16.95 days with a median of 15.00 days. Collar incision was applied in 19 cases (86.4%); in two cases (9.1%) a median sternotomy incision was used; and in the remaining case (4.5%), a right thoracotomy incision was made. The mean tracheal stenosis length was 2.14 cm (mean excision length, 2.5 cm). In 17 cases (77.3%), the anterior walls were supported with vicryl (polyglactin) suture one by one. No postoperative complications were observed in 12 cases (54.5%). No recurrence developed during the long-term follow-up of 15 of the 22 patients (68.2%). Two patients (9.1%) died in the early stages after surgery, and five patients (22.7%) had a stent inserted due to restenosis. CONCLUSION Tracheal resection and end-to-end anastomosis are the most efficient techniques in cases without medical contraindications, despite emerging stent or endoscopic procedures. Endoscopic interventions can be suggested as an alternative to surgery in patients for whom surgery cannot be performed or who develop recurrence.
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Affiliation(s)
- Ahmet Ulusan
- Department of Thoracic Surgery, Hitit University Corum Education and Research Hospital, Corum, Turkey.
| | - Maruf Sanli
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Ahmet Feridun Isik
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - İlknur Aytekin Celik
- Thoracic Surgery Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Bulent Tuncozgur
- Department of Thoracic Surgery, Ankara Guven Hospital, Ankara, Turkey
| | - Levent Elbeyli
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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19
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Zardo P, Kreft T, Hachenberg T. Airway Management via Laryngeal Mask in Laryngotracheal Resection. Thorac Cardiovasc Surg Rep 2016; 5:1-3. [PMID: 28018809 PMCID: PMC5177429 DOI: 10.1055/s-0035-1556061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022] Open
Abstract
We present a case of impassable subglottic stenosis scheduled for tracheal resection and reconstruction managed by establishing a supraglottic airway. Despite careful preoperative evaluation, the stenosis was localized higher than anticipated, rendering conventional intubation impossible. Laryngeal mask bridging to cross-field ventilation was feasible and jet ventilation and cardiopulmonary bypass were available as emergency strategies. Surgery and emergence went uneventful. Perioperative considerations are discussed in this report.
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Affiliation(s)
- Patrick Zardo
- Department of Cardiothoracic Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Tom Kreft
- Department of Anesthesiology and Intensive Care, Otto von Guericke University Magdeburg, Germany
| | - Thomas Hachenberg
- Department of Anesthesiology and Intensive Care, Otto von Guericke University Magdeburg, Germany
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20
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Abstract
Malignant tracheal neoplasms are rare diseases, mostly represented by squamous cell carcinoma (SCC) and adenoid cystic carcinoma (ACC). Symptoms presentation is often misleading and diagnosis may be delayed for months or years, so clinical suspicion plays a fundamental role. Corner stones in the diagnostic pathway are represented by rigid endoscopy and computed tomography (CT) scan, necessary to correctly stage the patients and identify the optimal surgical candidate. When appropriate, surgical resection and reconstruction is still the best opportunity to achieve a long-term survival with a good quality of life, but this kind of surgery is always a very challenging procedure and a wide experience with an in-depth knowledge of every technical detail, from selection of patient, to choice of surgical approach to reconstruction techniques, are needed and recommended.
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Affiliation(s)
- Federico Rea
- Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Andrea Zuin
- Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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21
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Ghali S, Chang EI, Rice DC, Walsh GL, Yu P. Microsurgical reconstruction of combined tracheal and total esophageal defects. J Thorac Cardiovasc Surg 2015; 150:1261-6. [PMID: 25998466 DOI: 10.1016/j.jtcvs.2011.10.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/08/2011] [Accepted: 10/09/2011] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Lesions involving both the trachea and the esophagus are often considered inoperable because of the lack of reliable reconstruction. The purpose of this study was to review our experience of combined supercharged jejunal and other flaps for tracheal and esophageal reconstruction. METHODS A retrospective review of 5 consecutive cases with combined tracheal and total esophageal defects was performed. The esophageal defect was reconstructed with a supercharged jejunal flap, and the trachea was reconstructed with a free anterolateral thigh flap or a pedicled muscle flap. RESULTS Primary diagnosis included tracheostoma recurrence after a total laryngectomy for laryngeal cancer in 2 patients and tracheoesophageal fistula due to esophageal stenting for complications from prior treatment for non-Hodgkin's lymphoma, parathyroid cancer, and esophageal cancer in 3 patients, respectively. Tracheal and esophageal reconstructions were staged in 4 patients, and 1 patient received simultaneous reconstruction. Tracheal necrosis developed in 1 patient with a mediastinal tracheostoma, and the patient eventually died of infection 2 months later. The other 4 patients recovered well and resumed an oral diet. CONCLUSIONS Complex and often life-threatening lesions involving both the trachea and the esophagus are not necessarily inoperable. With careful planning, these combined defects can be safely reconstructed with multiple flaps with good functional outcomes and reasonable survival.
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Affiliation(s)
- Shadi Ghali
- Department of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Edward I Chang
- Department of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Peirong Yu
- Department of Plastic Surgery, the University of Texas MD Anderson Cancer Center, Houston, Tex.
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22
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Abstract
OBJECTIVES/HYPOTHESIS Effective treatments for hollow organ stenosis, scarring, or agenesis are suboptimal or lacking. Tissue-engineered implants may provide a solution, but those performed to date are limited by poor mucosalization after transplantation. We aimed to perform a systematic review of the literature on tissue-engineered airway mucosa. Our objectives were to assess the success of this technology and its potential application to airway regenerative medicine and to determine the direction of future research to maximize its therapeutic and commercial potential. DATA SOURCES AND REVIEW METHODS A systematic review of the literature was performed searching Medline (January 1996) and Embase (January 1980) using search terms "tissue engineering" or "tissue" and "engineering" or "tissue engineered" and "mucous membrane" or "mucous" and "membrane" or "mucosa." Original studies utilizing tissue engineering to regenerate airway mucosa within the trachea or the main bronchi in animal models or human studies were included. RESULTS A total of 719 papers matched the search criteria, with 17 fulfilling the entry criteria. Of these 17, four investigated mucosal engineering in humans, with the remaining 13 studies investigating mucosal engineering in animal models. The review demonstrated how an intact mucosal layer protects against infection and suggests a role for fibroblasts in facilitating epithelial regeneration in vitro. A range of scaffold materials were used, but no single material was clearly superior to the others. CONCLUSION The review highlights gaps in the literature and recommends key directions for future research such as epithelial tracking and the role of the extracellular environment.
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SANNA S, MONTEVERDE M, TAURCHINI M, MENGOZZI M, GENESTRETI G, GROSSI W, ARGNANI D, BETTINI D, DELL’AMORE D. It could suddenly happen: delayed rupture of the trachea after total thyroidectomy. A case report. G Chir 2014; 35:65-68. [PMID: 24841680 PMCID: PMC4321588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION We report the case of a patient who presented with subcutaneous emphysema, dyspnea and cough 7 days after total thyroidectomy for cancer. In addition we review the Literature and discuss the therapeutic challenges as well as management options. CASE REPORT A 17-year old female patient underwent a total thyroidectomy with right cervical lymph adenectomy for papillar cancer. Lung metastases are present. On postoperative day 7 she presented with face and neck swelling due to subcutaneous emphysema, dyspnea and persistent cough. The radiological evaluation revealed a tear on the right antero-lateral wall of the trachea. The patient underwent surgical exploration of the neck which confirmed the tracheal rupture and showed an important tracheal necrosis all around the tear. Due to the impossibility to make primary closure of the trachea or a tracheal resection, the tear was repaired with muscular flap interposition, (around the trachea as a scarf ), using the contralateral clavicular part of sternocleidomastoid muscle and prethyroid muscles bilaterally. The postoperative course was uneventful and the patient is alive 20 months after surgery and iodine induced adjuvant therapy. CONCLUSION Delayed tracheal rupture should be suspected in all patients who present subcutaneous emphysema after thyroid surgery. The lesion should be promptly treated with primary closure or tracheal resection when possible. Muscular flap interposition could be a safe alternative option when the other procedures are contraindicated.
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Affiliation(s)
- S. SANNA
- Thoracic Department, Thoracic Surgery Unit, “G.B. Morgagni” Hospital, Forlì, Italy. Thoracic Department, Thoracic Surgery Unit, “S. Orsola” Universitary Hospital, Bologna, Italy
| | - M. MONTEVERDE
- Thoracic Department, Thoracic Surgery Unit, “G.B. Morgagni” Hospital, Forlì, Italy. Thoracic Department, Thoracic Surgery Unit, “S. Orsola” Universitary Hospital, Bologna, Italy
| | - M. TAURCHINI
- Thoracic Department, Thoracic Surgery Unit, “G.B. Morgagni” Hospital, Forlì, Italy. Thoracic Department, Thoracic Surgery Unit, “S. Orsola” Universitary Hospital, Bologna, Italy
| | - M. MENGOZZI
- Thoracic Department, Thoracic Surgery Unit, “G.B. Morgagni” Hospital, Forlì, Italy. Thoracic Department, Thoracic Surgery Unit, “S. Orsola” Universitary Hospital, Bologna, Italy
| | - G. GENESTRETI
- Oncologic Department, Oncology, “Bellaria” Hospital, Bologna, Italy
| | - W. GROSSI
- Thoracic Department, Thoracic Surgery Unit, “G.B. Morgagni” Hospital, Forlì, Italy. Thoracic Department, Thoracic Surgery Unit, “S. Orsola” Universitary Hospital, Bologna, Italy
| | - D. ARGNANI
- Thoracic Department, Thoracic Surgery Unit, “G.B. Morgagni” Hospital, Forlì, Italy. Thoracic Department, Thoracic Surgery Unit, “S. Orsola” Universitary Hospital, Bologna, Italy
| | - D. BETTINI
- Endocrine Surgery Unit, “G.B. Morgagni” Hospital, Forlì, Italy
| | - D. DELL’AMORE
- Thoracic Department, Thoracic Surgery Unit, “G.B. Morgagni” Hospital, Forlì, Italy. Thoracic Department, Thoracic Surgery Unit, “S. Orsola” Universitary Hospital, Bologna, Italy
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24
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Abstract
OBJECTIVES To review our experience of extracorporeal membrane oxygenation in airway management during tracheal surgery. METHODS A retrospective, observational study was conducted to evaluate the effectiveness of extracorporeal membrane oxygenation in tracheal surgery in Shanghai Chest Hospital between 2008 and 2012. RESULTS In all 91 tracheal surgeries, 7 high-risk cases used extracorporeal membrane oxygenation. The duration of extracorporeal membrane oxygenation support ranged from 10 min to 31 min. All extracorporeal membrane oxygenation patients underwent surgical procedures safely and there was no hospital mortality. CONCLUSIONS Although various advanced anesthesia techniques can ensure a safe airway in tracheal surgery in most cases, extracorporeal circulation plays an important role in high-risk cases.
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Affiliation(s)
- X Chang
- 1Department of Extracorporeal Circulation, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
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25
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Martinod E, Seguin A, Radu DM, Boddaert G, Chouahnia K, Fialaire-Legendre A, Dutau H, Vénissac N, Marquette CH, Baillard C, Valeyre D, Carpentier A. Airway transplantation: a challenge for regenerative medicine. Eur J Med Res 2013; 18:25. [PMID: 24059453 PMCID: PMC3750833 DOI: 10.1186/2047-783x-18-25] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022] Open
Abstract
After more than 50 years of research, airway transplantation remains a major challenge in the fields of thoracic surgery and regenerative medicine. Five principal types of tracheobronchial substitutes, including synthetic prostheses, bioprostheses, allografts, autografts and bioengineered conduits have been evaluated experimentally in numerous studies. However, none of these works have provided a standardized technique for the replacement of the airways. More recently, few clinical attempts have offered encouraging results with ex vivo or stem cell-based engineered airways and tracheal allografts implanted after heterotopic revascularization. In 1997, we proposed a novel approach: the use of aortic grafts as a biological matrix for extensive airway reconstruction. In vivo regeneration of epithelium and cartilage were demonstrated in animal models. This led to the first human applications using cryopreserved aortic allografts that present key advantages because they are available in tissue banks and do not require immunosuppressive therapy. Favorable results obtained in pioneering cases have to be confirmed in larger series of patients with extensive tracheobronchial diseases.
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Affiliation(s)
- Emmanuel Martinod
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Agathe Seguin
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Dana M Radu
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Guillaume Boddaert
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Kader Chouahnia
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Oncology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Anne Fialaire-Legendre
- Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, EFS Ile de France, Tissue Bank, Paris, France
| | - Hervé Dutau
- Assistance Publique-Hôpitaux de Marseille, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Nicolas Vénissac
- CHU Nice, Pasteur Hospital, Department of Thoracic Surgery, Nice, France
| | | | - Christophe Baillard
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Anesthesiology and Intensive Care, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Dominique Valeyre
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Pneumonology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Alain Carpentier
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
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26
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DeWitt RC, Hallman CH. Use of cardiopulmonary bypass for tracheal resection: a case report. Tex Heart Inst J 2004; 31:188-90. [PMID: 15212137 PMCID: PMC427386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Although ventilatory support can be life-saving, it also has adverse effects, including postintubation tracheal stenosis caused by damage to the larynx and trachea. Cardiopulmonary bypass is generally not used for the surgical management of tracheal stenosis; however, we have found that the use of cardiopulmonary bypass can be advantageous during tracheal resection and reconstruction.
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Affiliation(s)
- Robert Chance DeWitt
- The Department of Cardiothoracic Surgery, Texas Heart Institute at St. Luke' Episcopal Hospital, Houston, Texas 77030, USA
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