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Anterior tracheal suspension for tracheobronchomalacia in infants and children
Michael E Mitchell1, Nisreen Rumman2, Robert H Chun3
1Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
Insights
Direct anterior tracheal suspension (ATS) effectively improves respiratory status in children with severe tracheobronchomalacia. This surgical technique offers a promising solution for complex pediatric respiratory conditions, enhancing patient outcomes.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Respiratory Medicine
Background:
- Severe tracheobronchomalacia complicates care in infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis.
- Traditional methods like aortopexy show inconsistent results in preventing acute life-threatening events (ALTEs).
- Direct anterior tracheal suspension (ATS) was adopted to provide direct support to the anterior tracheal wall.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of direct anterior tracheal suspension (ATS) in pediatric patients with severe tracheobronchomalacia.
- To assess the impact of ATS on respiratory support levels and clinical status.
Main Methods:
- Twenty-one children with severe tracheobronchomalacia underwent ATS via median sternotomy.
- Indications included inability to ventilate, intermittent ALTEs, and recurrent respiratory admissions.
- Procedures were performed as isolated ATS or combined with other cardiac or tracheal surgeries, with a median follow-up of 30 months.
Main Results:
- No mortality was observed in the study cohort.
- Significant improvements in both respiratory support levels and clinical status were noted post-ATS compared to preoperative scores (p < 0.001).
- The outcomes were consistent regardless of whether ATS was performed in isolation or combined with other procedures.
Conclusions:
- Anterior tracheal suspension is a feasible and effective procedure for improving respiratory clinical status in children.
- ATS is applicable across a spectrum of anatomical variations.
- Further research is warranted to determine the long-term functional outcomes of this intervention.
Background:
Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to directly support the anterior tracheal wall, we have adopted the use of direct anterior tracheal suspension (ATS).
Methods:
Twenty-one children, median age 5 months (35 days to 11 years) and weight 5.0 (2.3 to 28.0) kg have undergone anterior tracheal suspension for severe tracheobronchomalacia through median sternotomy; 15 for inability to ventilate despite mechanical respiratory support, 3 for intermittent ALTEs without mechanical respiratory support, and 3 for recurrent respiratory admissions. Nine procedures were performed as isolated ATS and 12 procedures were combined with at least 1 of the following: repair of ventricular septal defect; vascular ring; atrioventricular canal; tracheal reconstruction or arterial-pexy. Level of respiratory support was graded at preoperative (preop), discharge, and follow-up, and respiratory clinical status was graded at preop and follow-up. Median follow-up was 30.0 months (2.0 to 57.0 months).
Results:
There was no mortality. Both level of respiratory support and the clinical status improved at all time points studied compared with preoperative score (p < 0.001) after ATS. Whether ATS was performed in isolation or combined with other procedures did not impact these findings.
Conclusions:
Anterior tracheal suspension is feasible and appears effective in dramatically improving respiratory clinical status. Tracheal suspension is applicable to a wide range of anatomic variants. Additional study is needed to characterize long-term functional outcomes.
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