Original article
General thoracic
Slide Tracheoplasty in Infants and Children: Risk Factors for Prolonged Postoperative Ventilatory Support

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.
https://doi.org/10.1016/j.athoracsur.2007.11.019Get rights and content

Background

A single-institution experience with slide tracheoplasty for management of tracheal stenosis in children with emphasis on identifying predictors of prolonged postoperative mechanical ventilation is reviewed.

Methods

Patient characteristics, hospital course, and outcomes for children undergoing slide tracheoplasty were recorded. Univariate and multivariate analysis was performed to identify factors leading to prolonged mechanical ventilation (>48 hours postoperatively).

Results

Since April 2001, 40 children underwent slide tracheoplasty utilizing cardiopulmonary bypass (CPB) support at a median age of 6.2 months (range, 7 days to 15 years), and median weight of 6.1 kg (range, 1.9 to 57 kg). Thirteen patients had undergone prior operations. Thirteen patients (32.5%) were mechanically ventilated before operation. Thirteen patients underwent additional procedures at the time of the slide tracheoplasty. Mean CBP support time was 123 minutes. Seven patients required aortic cross-clamping (mean, 69 minutes). There were 2 early and 2 late deaths, none related to the tracheoplasty. One patient required repair of a recurrent tracheal stenosis, 4 patients required tracheotomy, and 3 required temporary stent placement. Twenty-one patients (52.5%) were extubated within 48 hours after tracheoplasty. Univariate and multivariate analysis revealed only preoperative mechanical ventilatory support (odds ratio 28.4, p = 0.015) and duration of CPB support (odds ratio 1.06, p = 0.007) to be significant predictors of the need for prolonged intubation.

Conclusions

Slide tracheoplasty utilizing CPB support is a versatile and effective treatment for tracheal stenosis in children even when combined with repair of congenital cardiac anomalies. Most children can be successfully weaned from mechanical ventilatory support early after repair.

Section snippets

Patients and Methods

Forty infants and children underwent slide tracheoplasty at Cincinnati Children’s Hospital Medical Center from April 2001 through March 2006. Twenty boys and 20 girls underwent operation at a median age of 6.2 months (range, 7 days to 15 years) and a median weight of 6.1 kg (range, 1.9 to 57 kg). Age distribution is shown in Figure 1. Patient characteristics, hospital course, and outcomes were reviewed. Institutional Review Board approval with waiver for the need to obtain individual consent

Results

Twenty patients had associated cardiovascular anomalies, of which left pulmonary artery (LPA) sling was the most common (11). Six patients had ventricular septal defects (1 with left pulmonary artery sling also and another with pulmonary vein stenosis also). There were 3 cases of tetralogy of Fallot or double-outlet right ventricle with tetralogy physiology, 1 common atrium, and 1 LSVC to the left atrium without intra-atrial communication. Thirteen patients had undergone prior operations

Comment

Congenital long-segment tracheal stenosis is a challenging problem. Although it may become symptomatic across a variety of ages, the most common presentation is in the first months of life. We have often been surprised how well some of these infants may appear clinically at the time of initial diagnosis despite the severity of luminal narrowing of the trachea. In fact, quite a number of patients escaped recognition until they were found either to have difficulty with intubation for a nonairway

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