Outcome of congenital tracheal stenosis in children over two decades in a national cardiothoracic surgical unit

Abstract

Objective:To assess the outcomes of congenital tracheal stenosis among children.Materials and methods:A retrospective review of all children who underwent surgical repair of congenital tracheal stenosis reviewing charts, operative notes, echocardiograms, CT and MRI data from January 2002 to February 2019.Results:Twenty-six children underwent surgical treatment for tracheal stenosis. The median age was 3 months (range 0.3–35 months) and the median weight was 4.7 kg (range 2.5–13 kg) at the time of surgical intervention. Stridor was the most common presenting symptom in 17 patients (65% of patients). Twenty-one patients (81%) had concurrent cardiac anomalies, with pulmonary arterial sling being the most common, present in nine patients (34%). Extracorporeal life support was utilised in seven patients (27%) pre-operatively. Laryngeal release was required in 16 patients. In 7 patients an end-to-end anastomosis was performed, in 18 patients slide tracheoplasty, and 1 patient had a double slide tracheoplasty. The median cardiopulmonary bypass time was 106 minutes (range 25–255 minutes). The median cross-clamp time was 30 minutes (range 5–67 minutes). The median post-operative duration of ventilation was 5 days (range 0.5–16 days). The median ICU length of stay was 12.5 days (range 2–60 days). There were three hospital mortalities with 88% survival. One patient only required reintervention with balloon dilation. Twenty-two patients (85%) remained symptom-free on median follow-up at 7.6 years (range 0.2–17 years). Two patients since 2017 had 3D printed tracheas produced from CT imaging to assist surgical planning.Conclusion:Congenital tracheal stenosis can be managed effectively with excellent outcomes and 3D printed models assist in planning the optimal surgical intervention.

Systematic Review of Slide Tracheoplasty Outcomes

“…Once evaluated, each study was reviewed by 3 authors to confirm presence of specific pre-operative ECMO and cardiac information, which resulted in the inclusion of 7 studies for the systematic review and 5 studies for the hazard ratio analysis (Figure 1). 9-15…”

“…Once evaluated, each study was reviewed by 3 authors to confirm presence of specific pre-operative ECMO and cardiac information, which resulted in the inclusion of 7 studies for the systematic review and 5 studies for the hazard ratio analysis (Figure 1). [9][10][11][12][13][14][15] Studies for inclusion underwent quality assessment using standardized MINOR criteria tools. This tool was chosen due to its inherent design in evaluating surgical studies for rare diagnoses without a control group.…”

Congenital Tracheal Stenosis Patients Undergoing Modified Slide Tracheoplasty: Single-Centre Technique and Long-Term Morbidity and Mortality

“…CTS is often caused by an absence of the posterior membranous portion of the trachea being replaced by complete tracheal rings. 1 , 2 , 4 , 5 CTS can affect any section or length of the trachea ( Fig. 1 ), with long-segment tracheal stenosis generally defined as stenosis affecting >50% of the trachea.…”

“…Tracheal stenosis requiring resection and advancement beyond 30% of the trachea’s original length is difficult to address with this technique and often requires further augmentation. 1 , 4 , 10 , 11 , 12 Another option is a pericardial patch tracheoplasty. This involves creating a vertical incision in the stenotic segment of the trachea that is closed with a pericardial patch enlarging the tracheal segment.…”

“…Mortality rates from tracheal reconstruction have been demonstrated to be between 0% and 50% in the literature, and postoperative morbidity may be as high as 40%. 1 , 2 , 4 , 8 , 9 , 10 , 11 , 12 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Common complications after tracheal reconstruction include infection, intra- and postoperative bleeding, vocal cord paresis, tracheal obstruction, and growth of tracheal granulation tissue. 4 , 24 Factors that contribute to the difficulty of this repair include complex anatomy, increased incidence of other congenital malformations, and infrequent case presentation.…”