Related Experiment Videos
Repair of congenital tracheal stenosis
Carl L Backer1, Constantine Mavroudis, Lauren D Holinger
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA.
Insights
Tracheal autograft is the preferred method for long-segment tracheal stenosis in infants due to its all-autologous nature and ease of use. Tracheal resection is reserved for shorter segments.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Airway Anomalies
Background:
- Complete tracheal rings and tracheal stenosis are critical congenital airway anomalies.
- Surgical intervention is often necessary for infants with these conditions.
Purpose of the Study:
- To review short-term and long-term outcomes of six surgical techniques for complete tracheal rings and stenosis.
- To identify the optimal surgical approach for different severities of tracheal stenosis.
Main Methods:
- Retrospective review of 61 operations on 54 infants (7 days to 72 months) with complete tracheal rings and stenosis.
- Evaluation of pericardial tracheoplasty, tracheal autograft, tracheal resection, cartilage tracheoplasty, slide tracheoplasty, and aortic homograft patch tracheoplasty.
- Procedures performed with cardiopulmonary bypass; simultaneous repair of associated anomalies.
Main Results:
- Three early deaths (pericardial tracheoplasty, tracheal autograft) and eight late deaths (various techniques).
- Median hospital stay varied: tracheal resection (14 days), slide tracheoplasty (18 days), tracheal autograft (28 days), pericardial tracheoplasty (60 days).
- Tracheal autograft favored for long-segment stenosis; tracheal resection for <= 8 rings.
Conclusions:
- Tracheal autograft is the current procedure of choice for long-segment tracheal stenosis due to its advantages.
- Tracheal resection is suitable for limited-ring tracheal stenosis.
- Surgical technique selection depends on the extent of tracheal involvement and associated anomalies.
Abstract:
We have used six different techniques in 61 operations performed at Children's Memorial Hospital (Chicago, IL) between 1982 and 2001 on 54 infants with complete tracheal rings and primary or recurrent tracheal stenosis. Short-term and long-term outcomes are reviewed for all techniques including pericardial tracheoplasty, tracheal autograft, tracheal resection, cartilage tracheoplasty, slide tracheoplasty, and aortic homograft patch tracheoplasty. Patients' ages ranged from 7 days to 72 months; mean age at operation was 6 months. There were 33 boys and 21 girls. Associated pulmonary artery sling was present in 19 of 54 patients (35%). Significant associated intracardiac anomaly was present in 13 of 54 patients (24%). The number of complete tracheal rings involved ranged from two to 18 rings (mean, 14+/-5). All procedures were performed with the use of cardiopulmonary bypass. Simultaneous repair of pulmonary artery sling and cardiac abnormalities was undertaken. There were three early deaths, two after pericardial tracheoplasty and one after tracheal autograft. There were eight late deaths, five after pericardial tracheoplasty, one after tracheal autograft, one after slide tracheoplasty, and one after tracheal resection. Median length of hospital stay was 60 days for pericardial tracheoplasty, 28 days for tracheal autograft, 14 days for tracheal resection, and 18 days for the slide tracheoplasty. Follow-up is complete in all patients. Tracheal autograft is currently our procedure of choice for patients with long-segment tracheal stenosis because of its use of all-autologous material, technical ease of performance, already-present epithelial lining of the autograft, intrinsic maintenance of the cartilage contour, potential for growth, and ready availability. We limit the use of tracheal resections to patients with eight or less rings of tracheal stenosis.