Faculty Collaboration Database

Anterior tracheal suspension for tracheobronchomalacia in infants and children. Ann Thorac Surg 2014 Oct;98(4):1246-53

Date

08/05/2014

Pubmed ID

25086944

DOI

10.1016/j.athoracsur.2014.05.027

Scopus ID

2-s2.0-84908108437 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to directly support the anterior tracheal wall, we have adopted the use of direct anterior tracheal suspension (ATS).

METHODS: Twenty-one children, median age 5 months (35 days to 11 years) and weight 5.0 (2.3 to 28.0) kg have undergone anterior tracheal suspension for severe tracheobronchomalacia through median sternotomy; 15 for inability to ventilate despite mechanical respiratory support, 3 for intermittent ALTEs without mechanical respiratory support, and 3 for recurrent respiratory admissions. Nine procedures were performed as isolated ATS and 12 procedures were combined with at least 1 of the following: repair of ventricular septal defect; vascular ring; atrioventricular canal; tracheal reconstruction or arterial-pexy. Level of respiratory support was graded at preoperative (preop), discharge, and follow-up, and respiratory clinical status was graded at preop and follow-up. Median follow-up was 30.0 months (2.0 to 57.0 months).

RESULTS: There was no mortality. Both level of respiratory support and the clinical status improved at all time points studied compared with preoperative score (p < 0.001) after ATS. Whether ATS was performed in isolation or combined with other procedures did not impact these findings.

CONCLUSIONS: Anterior tracheal suspension is feasible and appears effective in dramatically improving respiratory clinical status. Tracheal suspension is applicable to a wide range of anatomic variants. Additional study is needed to characterize long-term functional outcomes.

Author List

Mitchell ME, Rumman N, Chun RH, Rao A, Martin T, Beste DJ, Berens RJ, Parakininkas DE, Ghanayem NS, Hubert MJ, Uhing M, Simpson P, Sato TT, Tweddell JS, Kerschner JE

Authors

Richard J. Berens MD Professor in the Anesthesiology department at Medical College of Wisconsin
David J. Beste MD Professor in the Otolaryngology department at Medical College of Wisconsin
Robert H. Chun MD Professor in the Otolaryngology department at Medical College of Wisconsin
Joseph E. Kerschner MD Provost, Executive Vice President, Dean, Professor in the School of Medicine Administration department at Medical College of Wisconsin
Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Daiva E. Parakininkas MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Michael R. Uhing MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child
Child, Preschool
Female
Humans
Infant
Male
Trachea
Tracheobronchomalacia