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Anterior pericardial tracheoplasty for congenital tracheal stenosis
D A Heimansohn1, K A Kesler, M W Turrentine
1University Medical Center, Department of Surgery, Indianapolis, Ind.
Insights
Anterior pericardial tracheoplasty effectively treats congenital long-segment tracheal stenosis in infants, offering a safe and beneficial surgical option for airway obstruction. This procedure demonstrates significant medium-term success, with most infants experiencing symptom relief and extubation.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Anomalies
Background:
- Congenital tracheal stenosis is a severe condition that can cause life-threatening airway obstruction in infants.
- Conventional airway intubation may not adequately relieve severe or long-segment tracheal stenosis.
- Anterior pericardial tracheoplasty has emerged as a potential surgical solution for this complex anomaly.
Purpose of the Study:
- To evaluate the safety and efficacy of anterior pericardial tracheoplasty for treating congenital long-segment tracheal stenosis in infants.
- To assess the medium-term outcomes and benefits of this surgical technique.
Main Methods:
- A retrospective review of eight infants who underwent nine anterior pericardial tracheoplasties over seven years.
- The surgical technique involves median sternotomy, partial cardiopulmonary bypass, and pericardial graft augmentation of the hypoplastic trachea.
- Postoperative outcomes, including survival, complications, and need for ventilation, were analyzed.
Main Results:
- Seven of eight infants survived the procedure without dehiscence or infection.
- Five infants were successfully extubated and remained symptom-free for 6 months to 5 years post-surgery.
- Two survivors had residual stenosis due to prior tracheostomy complications, with one requiring a second successful procedure.
Conclusions:
- Anterior pericardial tracheoplasty is a safe and effective procedure for infants with congenital long-segment tracheal stenosis, regardless of age or weight.
- The technique provides significant medium-term benefits, improving airway patency and reducing the need for long-term ventilation.
- This surgical approach offers a valuable treatment option for severe congenital tracheal anomalies.
Abstract:
Congenital tracheal stenosis may be a life-threatening anomaly not relieved by airway intubation. Over the past 7 years, anterior pericardial tracheoplasty has been used at our institution for treatment of congenital long-segment tracheal stenosis in infants with impeding airway obstruction. Case histories of eight patients undergoing nine anterior pericardial tracheoplasties have been reviewed to assess this technique. Of these patients, six have required preoperative tracheal intubation before repair to maintain ventilation. The surgical technique of anterior pericardial tracheoplasty includes a median sternotomy approach with partial normothermic cardiopulmonary bypass. An anterior tracheotomy through all hypoplastic rings allows enlargement with autologous pericardium to 1.5 times the predicted normal diameter. After insertion, the pericardium and hypoplastic tracheal cartilages are suspended to surrounding mediastinal structures, which prevents airway collapse. Seven of eight infants have survived without tracheoplasty dehiscence or wound infections. Five were ultimately extubated and are currently free of symptoms from 6 months to 5 years after anterior pericardial tracheoplasty. The other two survivors had residual stenosis as a result of complications of prior tracheostomy. One of these patients has undergone a successful second anterior pericardial tracheoplasty and is currently extubated and well. The other is palliated at 6 months with a tracheostomy awaiting a second anterior pericardial tracheoplasty. Our review of anterior pericardial tracheoplasty has demonstrated the safety, utility, and at least medium-term benefit of this procedure in infants of any age and weight.