Original article: general thoracicElective extracorporeal support for complex tracheal reconstruction in neonates
Section snippets
Patient population
Four neonates presented to our institution with severe respiratory distress requiring early intubation. All 4 infants were maintained on mechanical ventilation and required heavy sedation or paralysis, or both. Early rigid bronchoscopy was performed documenting the presence of long segment tracheal stenosis with varying amounts of complete rings and funnel type stenosis measuring no greater than 2 mm. Because of the tenuous airways, all the children were kept sedated to maintain endotracheal
Results
All 4 neonates survived the surgery without intraoperative complication and were removed from ECMO on postoperative days 4, 5, 8, and 9 (Table 2). There were no bleeding complications or tamponade despite sternal closure with ongoing heparinization. There were no neck infections, subcutaneous or mediastinal air, suture line leaks, or breakdown. The only complication possibly attributable to the intraoperative venoarterial ECMO run was transient acute tubular necrosis in the infant with a single
Comment
Numerous serious complications have been reported after complex tracheal reconstruction including tracheal leak or breakdown, infection and deep neck abscesses, airway obstruction and bleeding from granulation tissue, and restenosis 4, 5, 12, 13, 14. Extended paralysis and mechanical ventilation 2, 3 prevent trauma from motion, but they do not avoid positive pressure ventilation and manipulation of the airway to maintain pulmonary toilet and adequate gas exchange. Intraoperative extracorporeal
References (17)
- et al.
Tracheoplasty with pericardial patch for extensive tracheal stenosis in infants and children
J Thorac Cardiovasc Surg
(1984) - et al.
Congenital stenosis involving a long segment of the tracheafurther experience in reconstructive surgery
J Pediatr Surg
(1988) - et al.
Slide tracheoplasty for congenital funnel-shaped tracheal stenosis
Ann Thorac Surg
(1989) - et al.
Long-segment congenital tracheal stenosistreatment by slide-tracheoplasty
J Pediatr Surg
(1999) - et al.
Slide tracheoplasty for congenital tracheal stenosisa case report
J Pediatr Surg
(2000) - et al.
Complications of tracheal reconstruction
J Thorac Cardiovasc Surgery
(1986) - et al.
Congenital tracheal stenosisa review of 22 patients from 1965 to 1987
J Pediatr Surg
(1988) - et al.
Growth of tracheal anastomoses in lambs
J Thorac Cardiovasc Surg
(1990)
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Sliding tracheoplasty of complete tracheal cartilage rings in children
2023, Journal of Pediatric SurgeryCitation Excerpt :Slide tracheoplasty with cardiopulmonary bypass support has been adopted as the technique of choice in majority of centers that have reported significant experience in the management of these medically complex children. [10] ECMO support for complex tracheal reconstruction in neonates was suggested by Hines and Hansell and Connolly and McGuirt Jr. [11,12] Compared with conventional cardiopulmonary bypass (CPB), ECMO has less risk of hemorrhage since it requires less heparin administration than CPB and allows to continue respiratory support at postoperative period,if it isneeded. [13] Usually it is possible and desirable to correct congenital heart anomalies simultaneously during the same surgery, thus, this aspect should be discussed and carefully planned. [14]
A combination of tracheoplasty and tracheal stenting is an acceptable method of treating severe congenital tracheobronchial stenosis under extracorporeal membrane oxygenation
2019, Journal of Pediatric SurgeryCitation Excerpt :The median number of days to ECMO decannulation was 3.5; no ECMO-related complications were noted. Our results were comparable with those of previous series of perioperative ECMO support in patients with tracheal stenosis [9,10], suggesting that tracheoplasty on ECMO support is a viable option in patients not requiring cardiac defect repair. Balloon dilatation has been performed in selected cases with postoperative airway obstructions [1,2,11] in addition to its alternative application in the initial management of tracheal stenosis, in which the complete cartilage rings are split by expanding the balloon and thus increasing the tracheal diameter, after which the airway patency is maintained through endotracheal intubation for emergency management to maintain the airway before surgery [12].
Congenital diaphragmatic hernia and complete tracheal rings: The value of peri-operative ECMO
2019, Journal of Pediatric Surgery Case ReportsAdvances in Surgical Treatment of Congenital Airway Disease
2016, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :Simple resection and end-to-end reconstruction is an option for very short segment tracheal stenosis. Use of extracorporeal membrane oxygenation has been described as an adjunct for complex tracheal reconstructions as well.19 Relief of extrinsic compression alone, as stated earlier, is often not sufficient in alleviating respiratory symptoms in infants with TBM and CHD.
Congenital diaphragmatic hernia and complete tracheal rings: Repair on ECMO
2015, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Tsang et al. described the first tracheoplasty in 1989 without the use of ECMO [5]. Patients with complete tracheal rings usually do not necessitate preoperative stabilization with ECMO, unless they present with near complete stenosis and life threatening airway obstruction [6,7]. Although preoperative ECMO is not required, recent reports suggest that slide tracheoplasty should be performed on cardiopulmonary bypass if possible [4].
Venoarterial extracorporeal membrane oxygenation (VA ECMO) to facilitate combined pneumonectomy and tracheoesophageal fistula repair
2014, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The elective use of intraoperative ECMO for airway surgery was first demonstrated by Kamata et al, who used ECMO to support infants with congenital tracheal stenosis undergoing tracheal reconstruction with costal-cartilage grafts.7 Similarly, Hines and Hansel electively used ECMO to support neonates during complex tracheal reconstruction from congenital tracheal anomalies.8 This case report, while similar in its elective use of intraoperative ECMO for ventilatory support, is unique in the type of surgical repairs for which it was used and the particular anesthetic challenges these repairs presented.