Polyflex stenting of tracheomalacia after surgery for congenital tracheal stenosis

Area of Science:

• Pediatric surgery
• Respiratory medicine
• Biomedical engineering

Background:

• Severe long-segment tracheal stenosis in children poses significant management challenges.
• Surgical interventions like slide tracheoplasty and tracheal resection are complex and may not fully resolve airway instability.
• Persistent lower tracheal malacia often necessitates further intervention to maintain airway patency.

Observation:

• Three young children with life-threatening tracheal and bronchial stenosis underwent Polyflex self-expanding stent placement.
• Two patients had prior slide tracheoplasties with aortic homografts; one had tracheal resection and autotracheoplasty.
• Despite surgical repairs, all patients required stenting due to persistent lower tracheal malacia.

Findings:

• All three patients experienced complications, including granuloma formation, stent migration, and dislodgement.
• One patient developed a fatal tracheo-aortic fistula.
• Steroid treatment successfully managed granuloma in one case.
• One child ultimately survived following stenting.

Implications:

• Self-expanding stents in pediatric tracheal stenosis are associated with a high complication rate.
• While stenting can address malacia, it carries risks of serious adverse events, including fistula formation.
• Careful patient selection and monitoring are crucial when considering stenting for complex pediatric airway disorders.