The value of multidisciplinary aerodigestive evaluation in pediatric vascular ring and sling management: A...

Respiratory and feeding symptoms in children with vascular rings and slings are nonspecific and may not be solely attributable to the vascular anomaly. We evaluated the impact of Aerodigestive Clinic (ADC) assessment on long-term postoperative outcomes and characterized its diagnostic yield.

We retrospectively studied children with vascular rings or slings at a tertiary pediatric center (2011-2024), comparing those who underwent primary ADC evaluation with those who did not. The primary outcome was residual respiratory or feeding symptoms ≥1-year after repair. Multivariable regression assessed factors associated with symptom persistence.

Among 219 patients, 91 (41.6%) underwent primary ADC evaluation and 8 (3.7%) were evaluated post-repair. ADC assessment identified additional aerodigestive pathology prompting treatment modifications in 56.6% (56/99). Surgical repair was deferred in 57.1% (52/91) of patients undergoing primary ADC evaluation; 40.4% (21/52) had treatment modifications based on ADC findings. Overall, 118 patients (53.9%) underwent repair at a median age of 372 days (IQR 133-1030). Among 108 patients with ≥1-year follow-up, residual symptoms occurred in 30 (27.8%), including 21.9% of ADC patients and 30.3% of non-ADC patients. ADC involvement was not associated with reduced residual symptoms (adjusted OR 0.71; 95%CI 0.18-2.41; P = .6), whereas preoperative respiratory medication use predicted symptom persistence (adjusted OR 3.28; 95%CI 1.25-8.98; P = .02).

Despite the lack of statistically significant reduction in residual symptoms, ADC involvement identifies alternative causes of respiratory or feeding symptoms, informs surgical decision-making, guides pre- and postoperative management, and may, in some cases, defer the need for major cardiovascular surgery.