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Tracheoplasty should be proactively considered in the surgical strategy for treating the ring-sling complex
Xin-Wei Du1, Peng-Hui Wang1, Hao Wang1
1Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
Proactive tracheoplasty for pediatric ring-sling complex is safe and effective. Concurrent surgeries improved tracheal morphology and respiratory symptoms, especially in patients with significant stenosis or abnormal airway branching.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Congenital Airway Malformations
Background:
- Ring-sling complex is a rare congenital anomaly affecting the trachea and great vessels.
- Surgical management aims to relieve airway compression and improve respiratory function.
- The role of concurrent tracheal surgery alongside sling repair is debated.
Purpose of the Study:
- To evaluate the safety and efficacy of proactive tracheoplasty in children with ring-sling complex.
- To compare outcomes of concurrent sling and tracheal surgery versus staged or sling-only procedures.
- To identify predictors of successful surgical outcomes.
Main Methods:
- Retrospective analysis of 304 pediatric patients with ring-sling complex undergoing surgery across three centers.
- Patients were divided into three groups: concurrent sling and tracheal surgery (Group A), staged surgery (Group B), and sling-only surgery (Group C).
- Comparison of perioperative characteristics, tracheal morphology (narrow-wide ratio, subcarina angle), and clinical outcomes.
Main Results:
- Concurrent surgery (Group A) and staged surgery (Group B) showed significant improvement in narrow-wide ratio and subcarina angle compared to sling-only (Group C).
- Anomalous tracheobronchial arborization was more frequent in Groups A and B.
- Respiratory symptoms improved in Groups A and B, with persistent dysfunction in 7 patients in Group C.
Conclusions:
- Concurrent sling and tracheal surgery is a safe and effective approach for pediatric ring-sling complex.
- This approach is particularly beneficial for patients with a narrow-wide ratio ≤0.6, long-segment/diffuse tracheal stenosis, anomalous tracheobronchial arborization, and severe respiratory symptoms.
- Proactive tracheoplasty can lead to better functional outcomes in selected pediatric patients.
Objective:
To examine the safety and effectiveness of proactive tracheoplasty for pediatric ring-sling complex.
Methods:
We retrospectively collected data from 304 children who were diagnosed with a ring-sling complex and underwent surgery at 3 cardiac centers in China between January 2010 and June 2023. The children were categorized into 3 surgical groups: concurrent sling and tracheal surgery (group A; n = 258), staged sling and tracheal surgery (group B; n = 25), and sling-only surgery (group C; n = 21). We compared perioperative clinical characteristics, tracheal morphology changes, and outcomes across the 3 groups.
Results:
The median age of the children was 1.2 years (interquartile range, [IQR], 0.7-1.9 years). The anomalous tracheobronchial arborization rates were higher in group A (52.5%) and group B (60.0%) compared to group C (15.0%). The preoperative narrow-wide ratio (NWR) was lower in groups A and B than in group C, with values of 0.44 (IQR, 0.35-0.52), 0.44 (IQR, 0.33-0.59), and 0.68 (IQR, 0.54-0.72), respectively (P < .001). Preoperative subcarina angles were similar among the groups (P = .54). After specific surgeries, the NWR and subcarina angle were improved significantly in groups A and B but not in group C. There were 7 in-hospital deaths and 2 postdischarge deaths. Respiratory symptoms improved in groups A and B, but 7 children in group C remained in respiratory dysfunction. Six children presented with residual stenosis of the left pulmonary artery.
Conclusions:
Concurrent sling and tracheal surgeries for children with the ring-sling complex are safe and effective and are especially preferable for those with NWR ≤0.6, long-segment or diffuse tracheal stenosis, anomalous tracheobronchial arborization, and pronounced respiratory symptoms.
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