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Repair of long-segment tracheal stenosis in infancy
R D Jaquiss1, R P Lusk, T L Spray
1Department of Surgery, Washington University School of Medicine, St. Louis, Mo, USA.
Insights
Rib cartilage tracheoplasty effectively repairs long-segment tracheal stenosis in infants. This surgical technique, using cardiopulmonary bypass, offers excellent outcomes for infant airway reconstruction.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Cardiovascular Surgery
Background:
- Long-segment tracheal stenosis presents a significant surgical challenge in infants due to their critical condition and small airways.
- The optimal surgical repair strategy for this condition remains undefined.
Observation:
- This study reports on six infants undergoing rib cartilage tracheoplasty with cardiopulmonary bypass for long-segment tracheal stenosis.
- The procedure involved augmenting the anterior trachea with rib cartilage after incision along the stenosis length.
- Cardiopulmonary bypass was utilized in all cases to facilitate precise repair of the infant airway.
Findings:
- All six patients survived the procedure with good intermediate-term follow-up (mean 4.7 years).
- Complications included one case of ventricular dysfunction requiring extracorporeal membrane oxygenation and one instance of graft dehiscence requiring revision.
- The majority of patients experienced symptom-free recovery and normal growth post-surgery.
Implications:
- Rib cartilage tracheoplasty is a viable and effective surgical option for long-segment tracheal stenosis in infants.
- The use of cardiopulmonary bypass enhances surgical precision in repairing small infant airways.
- This technique demonstrates excellent results, offering a promising solution for a challenging pediatric surgical condition.
Abstract:
Long-segment stenosis of the trachea in infancy is a considerable surgical challenge because the infants are generally extremely ill and the airway is small. The optimal type of repair is not clearly defined. This report summarizes our experience with rib cartilage tracheoplasty done with cardiopulmonary bypass. Six patients underwent repair of long-segment tracheal stenosis between September 1987 and September 1994. The mean age was 14 weeks (range 1 to 58 weeks). Patients had stenosis of at least 70% of the tracheal length, typically with complete cartilaginous rings. In all patients stenosis was repaired by placement of a section of rib cartilage as an augmentation patch into the anterior surface of the trachea, which had been incised through the entire length of the stenosis. To avoid distal airway intubation, we used cardiopulmonary bypass for all procedures, with a mean bypass duration of 110 minutes (range 54 to 175 minutes). Mechanical ventilation was required for a median of 11 days after the operation (range 7 to 81 days), and the median postoperative hospital stay was 17 days (range 12 to 180 days). All patients are long-term survivors. Complications included the need for extracorporeal membrane oxygenation to treat ventricular dysfunction in one patient and graft dehiscence requiring revision of the distal graft in another. The latter patient has required several treatments with a bronchoscope for removal of granulation tissue. All other patients are free of symptoms and have normal growth with a mean follow-up of 4.7 years (range 5 months to 7.6 years). We conclude that rib cartilage tracheoplasty for long-segment tracheal stenosis provides excellent results in short and intermediate follow-up. In addition, the use of cardiopulmonary bypass allows an unobstructed view of the tiny infant airway and thus permits a precise repair.