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Slide tracheoplasty outcomes in children with congenital pulmonary malformations
Michael A DeMarcantonio1, Catherine K Hart1,2, Christina J Yang3
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
Insights
Slide tracheoplasty is effective for congenital tracheal stenosis. However, children with pulmonary malformations face a more complex recovery, including higher risks of prolonged ventilation, ECMO, and increased mortality.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Malformations
Background:
- Congenital tracheal stenosis is a serious condition requiring surgical intervention.
- Slide tracheoplasty is a common surgical technique for treating tracheal stenosis.
- The impact of concomitant pulmonary malformations on surgical outcomes is not fully understood.
Purpose of the Study:
- To evaluate and compare the surgical outcomes of slide tracheoplasty in children with congenital tracheal stenosis.
- To specifically assess differences in outcomes between patients with and without pulmonary malformations.
Main Methods:
- Retrospective chart review of patients undergoing slide tracheoplasty between 2001 and 2014.
- Inclusion of patients with and without congenital pulmonary malformations.
- Analysis of preoperative, postoperative, and mortality data.
Main Results:
- Patients with pulmonary malformations had higher rates of preoperative mechanical ventilation, ECMO, and tracheostomy.
- Postoperatively, these patients required more prolonged mechanical ventilation and ECMO.
- No significant differences were observed in tracheostomy, dehiscence, restenosis, or figure 8 deformity rates.
- Mortality was significantly higher in the group with pulmonary malformations (22.2% vs. 3.6%).
Conclusions:
- Slide tracheoplasty is a viable treatment for tracheal stenosis even in the presence of pulmonary malformations.
- Surgeons and families must be prepared for a more challenging postoperative course in these complex cases.
- Anticipation of prolonged ventilation, ECMO use, and increased mortality is crucial for patients with combined tracheal and pulmonary anomalies.
Objectives/Hypothesis:
Evaluate and compare surgical outcomes of slide tracheoplasty for the treatment of congenital tracheal stenosis in children with and without pulmonary malformations.
Study Design:
Retrospective chart review at a tertiary care pediatric medical center.
Methods:
We identified patients with tracheal stenosis who underwent slide tracheoplasty from 2001 to 2014, and a subset of these patients who were diagnosed with congenital pulmonary malformations. Hospital course and preoperative and postoperative complications were recorded.
Results:
One hundred thirty patients (18 with pulmonary malformations, 112 with normal pulmonary anatomy) were included. Pulmonary malformations included unilateral pulmonary agenesis (61%) and hypoplasia (39%). Children with pulmonary malformations had a greater median age compared to their normal lung anatomy counterparts. Preoperatively, patients with pulmonary malformations more frequently required preoperative mechanical ventilation (55.6% vs. 21.3%, P = .007), extracorporeal membrane oxygenation (ECMO) (11% vs. 0.9%, P = .05), and tracheostomy (22.2% vs. 3.6%, P = .01). Postoperatively, patients with pulmonary malformations more frequently required mechanical ventilation >48 hours (78% vs. 37%, P =.005) and ECMO use (11% vs. 0.9%, P = .05). Pulmonary malformation patients and children with normal anatomy did not differ in terms of postoperative tracheostomy (16.7% vs. 4.4%, P > .05), dehiscence (6% vs. 0%, P > .05%), restenosis (11% vs. 6%, P > .05) or postoperative figure 8 deformity (6% vs. 3%, P > .05). Mortality, however, was significantly increased (22.2% vs. 3.6%, P = .01) in children with pulmonary malformations.
Conclusions:
Although slide tracheoplasty can be successfully performed in patients with abnormal pulmonary anatomy, surgeons and families should anticipate a more difficult postoperative course, with possible associated prolonged mechanical ventilation, ECMO use, and higher mortality than in children with tracheal stenosis alone.
Level Of Evidence:
4. Laryngoscope, 127:1283-1287, 2017.
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