One slide fits all: The versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children

Abstract

Slide tracheoplasty with cardiopulmonary bypass can be performed with low mortality in a diverse pediatric population. This technique minimizes need for early significant airway reintervention in most cases.

Tracheal and bronchial stenoses and other obstructive conditions

“…Presentation is similar to CTRs; however, bronchoscopically, the stenotic segment lacks cartilage and is therefore distensible (11). This anomaly is generally managed with either a tracheal resection or a slide tracheoplasty (1,11).…”

“…Most pediatric tracheal stenosis manifests as complete tracheal rings (CTRs), with the absence of a membranous trachea extending for varying lengths of the airway. Other congenital malformations as well as acquired lesions are also encountered (1). Children with congenital tracheal or bronchial stenosis are frequently complex and can present with concurrent anomalies, including pulmonary artery sling, ventricular septal defects, lung hypoplasia, lung agenesis, and gastrointestinal defects (2,3).…”

“…A large series conducted at Cincinnati Children's Hospital Medical Center [2011] revealed that 60% of patients with CTRs had cardiovascular abnormalities, most commonly a pulmonary artery sling (1).…”

Extracorporeal support in airway surgery

“…J Thorac Dis 2017;9(7):2108-2117 jtd.amegroups.com explained by the high percentage of concomitant defects of the heart and great vessels, which are often corrected in the same operation as the slide tracheoplasty (68). The drawback to CPB is that it generally requires a median sternotomy in children and therefore limits the surgical approaches to the trachea.…”

Operative or non-operative treatment of congenital tracheal stenosis: is there something new?

“…Increasing experience with this procedure has dramatically improved the outcomes of CTS, in contrast to what Hong et al (1) describe in their article. This surgical technique is effective, versatile and its indications are expanding from long segment CTS to short segment CTS, tracheal stenosis with bronchial extension, and even other tracheal diseases such as recurrent tracheoesophageal fistula (11,12). Moreover, its main advantage lays on the fact that reconstruction is performed using native tracheal tissue so granulation tissue formation is minimal compared to other surgical techniques using cartilage or pericardial grafts (5).…”