Thoracoscopic Aortopexy for Treatment of Tracheomalacia in Infants and Children

Abstract

Thoracoscopic aortopexy is an effective treatment for severe tracheomalacia not controlled by conservative measures. It can be safely performed even in small infants as long as equipment and skill for pediatric thoracoscopy are available. The authors believe that thoracoscopic exposure offers advantages over open technique and is cosmetically more pleasing to patients and their families. It may result in less pulmonary complications, shorter hospital stay, and less narcotic requirement compared to open thoracotomy.

Treatment of Tracheomalacia with Aortopexy in Children in Glasgow

“…This procedure can be performed through a limited thoracotomy through the second or third left interspace next to the sternum, via a sternotomy or thorascopically. 10 None of the children in this series underwent a thorascopic procedure. Only one child in this series required a tracheal stent, which was in addition to a tracheostomy.…”

Direct tracheobronchopexy to correct airway collapse due to severe tracheobronchomalacia: Short-term outcomes in a series of 20 patients

“…In this series of 20 patients, we show that the use of direct tracheobronchopexy, with either anterior suspension and/or posterior fixation for severe TBM, resulted in anatomic correction and resolution of ALTEs at follow-up and also significantly reduced the incidence of recurrent pneumonias. Either open aortopexy, or more recently, thoracoscopic aortopexies, has been used to treat TM and TBM [14][15][16]. Other operative options have included surgical lateropexia, tracheal reconstruction, external stabilization, tracheostomies and suspensions [14,17].…”

Pediatric tracheomalacia and the perioperative anesthetic management of thoracoscopic posterior tracheopexy

“…Preliminary outcomes from tracheoaortopexy and posterior tracheopexy seem promising, and are traditionally performed as open procedures. Tracheoaortopexy alleviates anterior vascular compression of the trachea by elevating the aorta and suturing it to the posterior aspect of the sternum, while posterior tracheopexy addresses a malformed posterior trachea and membranous tracheal intrusion . This is accomplished by stenting open the trachea through the attachment of the posterior tracheal membrane to the anterior longitudinal spinal ligament under direct bronchoscopic guidance via thoracotomy …”

“…The etiology, degree of tracheal narrowing, and severity of clinical symptoms dictates the treatment . A novel approach, thoracoscopic posterior tracheopexy, involves stenting the trachea by attaching the posterior trachea to the anterior longitudinal spinal ligament under guidance of fiberoptic bronchoscopy (FOB) . Although this minimally invasive technique is advantageous for patients with compromised respiratory mechanics, the simultaneous need for operative FOB guidance and lung isolation makes for a challenging anesthetic.…”

“…4 A novel approach, thoracoscopic posterior tracheopexy, involves stenting the trachea by attaching the posterior trachea to the anterior longitudinal spinal ligament under guidance of fiberoptic bronchoscopy (FOB). 2,3,5 Although this minimally invasive technique is advantageous for patients with compromised respiratory mechanics, the simultaneous need for operative FOB guidance and lung isolation makes for a challenging anesthetic. We describe the management of a complex pediatric patient undergoing a novel approach to a relatively new treatment-thoracoscopic posterior tracheopexy, review the literature on pediatric tracheomalacia, and examine the newest treatment options to highlight the potential challenges and pitfalls associated with caring for these patients.…”