Elsevier

The Annals of Thoracic Surgery

Volume 92, Issue 5, November 2011, Pages 1870-1874
The Annals of Thoracic Surgery

New technology
First Experience With Biodegradable Airway Stents in ChildrenDisclaimer

https://doi.org/10.1016/j.athoracsur.2011.07.042Get rights and content

Purpose

We here report our experience with biodegradable polydioxanone stents for tracheal narrowing in children.

Description

Eleven custom-made polydioxanone stents were implanted in 4 patients with airway narrowing due to external compression or intrinsic collapse. The median stent diameter was 9 mm (range, 6 to 14 mm) and median length was 15 mm (range, 13 to 70 mm).

Evaluation

Narrowing was relieved initially in all cases. There was no bleeding or perforation after polydioxanone stent implantation. Size mismatching was a problem in 2 cases. Three patients needed repeat stenting after stent absorption. There was 1 death, unrelated to the stent implantation. All 3 survivors are in good clinical condition up to 12 months after first stenting.

Conclusions

This pilot study shows that polydioxanone stents offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children. They may avoid the need for permanent stenting and allow subsequent growth of the airway.

Section snippets

Technology

This study was approved by our Institutional Research Ethics Committee. Informed consent was obtained from the parents of each child. Self-expanding biodegradable polydioxanone stents (Ella-CS, Hradec Kralove, Czech Republic) were custom manufactured in appropriate sizes from commercially available polydioxanone surgical suture of size EP3, which has a diameter of 0.340 mm to 0.399 mm.

Technique

The decision to perform stenting was made by our multidisciplinary tracheal team, based on clinical status and imaging studies, including bronchoscopy. In general, we do not use stents in children if there is a feasible surgical alternative for correction of the airway obstruction. The sizes of the stents used were decided on the basis of measurements made at computed tomography, bronchography, and in 1 patient by inflation of an angioplasty balloon (Table 1).

The stent was delivered in an

Clinical Experience

Eleven stenting procedures were performed in 4 patients. Narrowing was relieved immediately in all cases, without airway bleeding or perforation. Three patients needed repeated stenting after stent absorption, as expected. Absorption was complete after 15 weeks. One patient died after withdrawal of care; the 3 survivors are in good ventilatory condition at as long as 12 months of follow-up since first stent insertion.

Patient 1

This 5-month-old female presented after two near-death experiences caused by severe tracheal compression by the posteriorly shifted ascending aorta after an arterial switch operation performed elsewhere. Further surgery was considered inadvisable owing to her small size (2.8 kg), and a polydioxanone stent was inserted. There was an immediate clinical improvement, from stressful and extremely noisy gasping ventilation to almost normal breathing, but as the stent dissolved, the compression

Comment

Various stenting options are available for the airway. In our practice, we have used balloon-expandable permanent and retrievable self-expanding metal stents, as well as silicone and plastic retrievable stents. Each type has its advantages and limitations [10].

Polydioxanone stents are more difficult to insert than metal stents, and the size of the introducer does not allow stent placement under direct vision. Apnea (of up to 140 s) was necessary, but was well tolerated. Bronchography and the

Disclosures and Freedom of Investigation

The equipment used in this study was purchased from our normal budget. The authors had full control of the design of the study, methods used, outcome measurements, analysis of data, and production of the written report.

References (10)

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Disclaimer

The Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, and The Annals of Thoracic Surgery neither endorse nor discourage use of the new technology described in this article.

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