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Further experience with polydioxanone airway stents in children
Rocío Morante-Valverde1, María López Díaz1, Mª Carmen Luna-Paredes2
1Pediatric Surgery Division & Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
Insights
Biodegradable polydioxanone (PDO) airway stents are safe and effective for treating severe pediatric tracheobronchial obstruction. Further research is needed on managing granulation tissue and optimizing degradation times for these airway stents.
Area of Science:
- Pediatric Pulmonology
- Biomaterials Science
- Medical Device Engineering
Background:
- Severe central airway obstruction in children presents significant management challenges.
- Biodegradable polydioxanone (PDO) stents offer a potential solution for pediatric airway issues.
- Experience with PDO stents in pediatric populations requires ongoing evaluation for safety and efficacy.
Purpose of the Study:
- To update the clinical experience with biodegradable polydioxanone (PDO) airway stents in pediatric patients.
- To assess the effectiveness and safety of PDO stents in managing severe tracheobronchial obstruction.
- To identify factors influencing outcomes in children treated with PDO airway stents.
Main Methods:
- Retrospective analysis of pediatric patients treated with PDO stents between 2012 and 2023.
- Collection of data on patient demographics, comorbidities, stent characteristics, and clinical outcomes.
- Statistical analysis to determine the impact of various factors on treatment outcomes.
Main Results:
- Fifty-four PDO stents were placed in 26 children with severe airway obstruction (tracheomalacia, bronchomalacia, stenosis).
- Complete resolution occurred in 30.7% of patients, with partial improvement in 50%.
- Younger age and smaller stent size correlated with better outcomes; granulation tissue was the most common complication.
Conclusions:
- Biodegradable polydioxanone (PDO) airway stents are safe and effective for severe pediatric tracheobronchial obstruction.
- Granulation tissue formation remains a significant complication requiring further investigation.
- Optimization of PDO stent degradation profiles and management of complications warrant future research.
Introduction:
The aims of this study were to update our experience with biodegradable polydioxanone (PDO) airway stents in children, focusing on effectiveness and safety, and to analyze the factors involved in the different outcomes observed.
Materials And Methods:
Retrospective study of patients managed with PDO stents from 2012 to 2023. Variables collected: demographics, comorbidities, indication, clinical baseline, stent size, location, complications, clinical outcome, and time of follow-up. Statistical analyses were performed to detect the eventual contribution of variables in the different outcomes observed.
Results:
Fifty-four PDO stents were placed in 26 patients (median age, 4 months). All showed severe symptoms of central airway obstruction due to tracheomalacia in nine patients, bronchomalacia five, tracheobronchomalacia 10, and tracheal stenosis two. Stent placement was uneventful in every case: 29 stents in the trachea and 25 in the main bronchi. 53.8% of patients needed successive stenting, and all exhibited comorbidities. Complete clinical resolution was observed in eight cases (30.7%), partial improvement in 13 (50%), unchanged in 4 (15.3%), and worsened in one. Age had a significant positive impact on outcome (6 vs. 3 months; p = 0.024). Additionally, smaller stents were associated with a better outcome (20 vs. 26 mm; p = 0.044). Granulation tissue was the most frequent complication (34.6%). Five patients (19.2%) died due to severe comorbidities, follow-up was complete in survivors (median, 58 months).
Conclusions:
PDO stents are safe and effective when dealing with severe tracheobronchial obstruction. Stent-related granulation tissue continues to be a relevant matter of concern. This issue, together with increased degradation times, deserves further research.
