Residual tracheobronchial malacia after surgery for vascular compression in children: treatment with stenting†

Serio, Paola; Nenna, Raffaella; Fainardi, Valentina; Grisotto, Laura; Biggeri, Annibale; Leone, Roberto; Arcieri, Luigi; Maurizio, Marco Di; Colosimo, Denise; Baggi, Roberto; Murzi, Bruno; Mirabile, Lorenzo; Midulla, Fabio

doi:10.1093/ejcts/ezw299

Cited by 6 publications

(8 citation statements)

References 28 publications

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“…Endotracheal stents for tracheomalacia are associated with minimal immediate procedural risk and could therefore be considered as an alternative in highly selected cases. Furthermore, stenting poses a second-line treatment after failed surgical correction (14). However, long-term success is limited by formation of granulation tissue, recurrent infections and secondary cicatricial stenosis (15).…”

Section: Localized Tracheomalacia-vascular Ringsmentioning

confidence: 99%

Pediatric airway surgery

Höetzenecker¹,

Schweiger²,

Denk-Linnert³

et al. 2017

J. Thorac. Dis.

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The pediatric airway-general implicationsThe pediatric airway has several distinct features compared to the adult airway. First, dimensions are much smaller. This is particularly important with regards to the subglottis. The inner-diameter of the subglottis of a newborn usually measures between 3 and 4 mm (1). A pathological process in this area, leading to a circular lumen reduction of only one millimeter, can result in a life-threatening near-occlusion.A second feature of the pediatric airway is that the cartilaginous parts are still malleable and cannot provide the same stability as an adult airway skeleton. This can become a problem after airway reconstructions and usually results in the need of prolonged postoperative stentings to support a laryngotracheal repair. The lack of stability of the trachea in a newborn (compared to an adult) also makes it more prone to develop tracheomalacia. Vessel malformations (vascular rings) can apply pressure to the airway, causing dynamic collapse and making surgical correction often inevitable (2).On the other hand, the flexibility of the pediatric trachea facilitates long-segmental resections. In children, up to 50 percent of the airway length can be resected without extensive tension on the anastomosis (3).With regards to the functional aspects of the pediatric larynx, the anatomical relationship between the glottis and the hyoid is also a unique feature. The thyrohyoid membrane is shorter than in adults and the thyroid notch usually projects behind the hyoid. This high location of the larynx raises the tip of the epiglottis behind the uvula, thus, permitting simultaneous breathing and swallowing (4). Consequently, swallowing problems are rare in children and the pediatric larynx can handle even profound changes in its configuration. In fact, extensive laryngotracheal resections and reconstructions are possible without risking severe postoperative swallowing problems. Diseases of the pediatric airway Laryngotracheal stenosisAirway injury secondary to traumatic intubation remains the most common cause of laryngotracheal stenosis, accounting for about 90% of all pediatric acquired airway stenosis (5). The majority of intubation-related injuries are due to the comorbidities. This comprehensive review should give an overview on most common airway problems in neonates and children as well as available surgical techniques.

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Section: Localized Tracheomalacia-vascular Ringsmentioning

confidence: 99%

Pediatric airway surgery

Höetzenecker¹,

Schweiger²,

Denk-Linnert³

et al. 2017

J. Thorac. Dis.

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“…Dislocation and mucous obstruction are probably the other major complications mostly present using silicon and hybrid stents. 12,14 The impossibility of being re-epithelizated makes it easier to remove them anytime, but recurrent infections caused by mucous accumulation and dislocation must be taken into account. 11 Migration is a complication totally avoided with the SS design, as it has a fixation point in the tracheal ring, and it has not been observed in any case.…”

Section: Clinical and Image Follow-upmentioning

confidence: 99%

A new airway spiral stent designed to maintain airway architecture with an atraumatic removal after full epithelization—Research of feasibility and viability in canine patients with tracheomalacia

Serrano‐Casorran

López-Mínguez

Rodriguez‐Zapater

et al. 2020

Pediatric Pulmonology

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Objective Surgical management of tracheomalacia is a challenge, with current treatments still presenting numerous complications. In the field of veterinary medicine, this same pathology is present in a significant number of dogs. For this reason, we present an experimental clinical trial performed on canines with tracheobronchomalacia, using a new atraumatic removable tracheal spiral stent (SS). Both implantation procedure and clinical improvement have been analyzed in this study. Methods In this study, four small dogs, a mean weight of 4.89 kg and body condition scores IV‐V, were included. SS was implanted by two different surgical approaches. Image and clinical follow‐up have been performed during 90 days. Symptoms were evaluated from 1 to 10 every week. Results This study achieved 100% technical and clinical success. Median tracheal diameters were as follows: cervical 10.85 (3.3), inlet 7.75 (2.1), and carina 7.75 (1.9) mm, and length was 77.5 (26) mm. A 12 × 10 × 100‐mm SS was implanted in all cases. Goose honk cough punctuation improved from 8 to 1; also, there were important changes in exercise intolerance, a mean weight loss of 8.76%. The values of modified Karnofsky scale varied from 50 (20) before surgery to 90 (10) after 30 days of surgery. Neither granuloma tissue nor fractures of the prosthesis was observed. Conclusion The results in dogs are promising, and a new therapeutic alternative seems to be available for veterinarian field. The similarity of this disease between dogs and newborns suggests that this SS design can also be useful for human trials.

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“…14 Some researchers have used metallic stents successfully and found that the re-epithelialization of the airway occurs without airway obstruction. 15 Extrinsic vascular airway compression in children following cardiac surgery is particularly problematic to manage and results in delayed extubation, repeated hospitalizations, and long-standing severe respiratory symptoms and, often, tracheostomy and positive pressure ventilation. The introduction of biodegradable intraluminal airway stents to maintain patency post–lung transplantation in adults has opened the door to their use in children.…”

Section: The Airwaymentioning

confidence: 99%