Posterior tracheopexy for severe tracheomalacia

Area of Science:

• Pediatric Surgery
• Respiratory Medicine
• Thoracic Surgery

Background:

• Severe tracheomalacia often involves posterior membranous tracheal intrusion, which is not addressed by anterior aortopexy.
• Aortopexy is a common treatment for anterior vascular compression in tracheomalacia.
• The efficacy of posterior tracheopexy for posterior tracheal wall collapse requires further investigation.

Purpose of the Study:

• To evaluate patient outcomes following posterior tracheopexy for tracheomalacia with posterior intrusion.
• To assess the resolution of clinical symptoms and improvement in airway collapse via bronchoscopy.
• To determine the effectiveness of posterior tracheopexy in managing posterior tracheal wall collapse.

Main Methods:

• Retrospective review of patients who underwent posterior tracheopexy between October 2012 and March 2016.
• Collection of data on clinical symptoms, tracheomalacia scores (dynamic airway evaluation), and persistent airway intrusion.
• Statistical analysis using Wald and Wilcoxon signed-ranks tests.

Main Results:

• 98 patients underwent posterior tracheopexy, with a median age of 15 months.
• Statistically significant improvements were observed in multiple clinical symptoms (e.g., cough, noisy breathing, respiratory infections) and ventilator dependence (p<0.001 and p=0.04, respectively).
• Bronchoscopic evaluation showed significant improvement in tracheomalacia scores across all tracheal and bronchial regions (p<0.001), with 9.2% requiring reoperation for persistent airway intrusion.

Conclusions:

• Posterior tracheopexy is an effective treatment for severe tracheomalacia characterized by posterior tracheal intrusion.
• The procedure leads to significant improvements in both clinical symptoms and objective measures of airway collapse.
• Posterior tracheopexy offers a valuable therapeutic option for managing complex cases of tracheomalacia.