New technologyFirst Experience With Biodegradable Airway Stents in ChildrenDisclaimer
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.
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Cited by (0)
- 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.