Surgical management strategy of slide tracheoplasty for infants with congenital tracheal stenosis

Liqin Chen; Limin Zhu; Hao Wang; Zhaohui Lu; Zhiwei Xu; Xinwei Du; Shunmin Wang

doi:10.1016/j.jtcvs.2021.10.047

Surgical management strategy of slide tracheoplasty for infants with congenital tracheal stenosis

J Thorac Cardiovasc Surg. 2022 Jun;163(6):2218-2228. doi: 10.1016/j.jtcvs.2021.10.047. Epub 2021 Nov 4.

Authors

Liqin Chen¹, Limin Zhu¹, Hao Wang¹, Zhaohui Lu², Zhiwei Xu¹, Xinwei Du³, Shunmin Wang⁴

Affiliations

¹ Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
² Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Pediatric Surgery, Sanya Women and Children's Hospital, affiliated to Shanghai Children's Medical Center, Hainan, China.
³ Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: duxinwei@scmc.com.cn.
⁴ Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Pediatric Surgery, Sanya Women and Children's Hospital, affiliated to Shanghai Children's Medical Center, Hainan, China. Electronic address: wangshunmin@scmc.com.cn.

PMID: 34872757
DOI: 10.1016/j.jtcvs.2021.10.047

Abstract

Objective: The study objective was to evaluate the outcomes of slide tracheoplasty in infancy and identify predictors of adverse outcomes.

Methods: We retrospectively reviewed the clinical data of infants aged less than 1 year with congenital tracheal stenosis who underwent slide tracheoplasty at a single center from April 2010 to September 2020.

Results: Of 120 infants, 71.7% (86/120) had a pulmonary artery sling and 37.5% (45/120) had simultaneous intracardiac repairs. Additionally, 52.5% (63/120) of the patients had anomalous tracheobronchial arborization, and 17.5% (21/120) had diffuse tracheal stenosis. Six airway reoperations (5%) and 6 deaths (5%) occurred, and the mortality decreased annually. Multivariate analysis revealed that a low body weight, cardiovascular anomalies, and normal tracheobronchial arborization predicted a longer intubation duration. Univariate analysis revealed that a low body weight, preoperative invasive ventilation, a long cardiopulmonary bypass time, and granulation tissue were associated with death. After surgery, 26 patients had dysphagia, 24 of whom resumed oral feeding during follow-up. Ninety-two patients underwent chest computed tomography reexamination, and the trachea diameter had increased significantly from 2.32 ± 0.72 mm to 5.46 ± 1.24 mm. Nineteen and 29 patients underwent spirometry before and after surgery, respectively, and showed improvements in ventilation function, with the ratio of time to peak tidal expiratory flow to total expiratory time and ratio of volume to peak tidal expiratory flow to total expiratory volume values significantly improved from 19.80% (interquartile range, 16.90-23.80) and 23.10% (interquartile range, 21.10-25.90) to 26.80% (interquartile range, 21.20-34.40) and 30.20% (interquartile range, 25.00-34.50), respectively (P < .05).

Conclusions: A tailored individual management strategy of slide tracheoplasty in infancy facilitates favorable clinical outcomes. Close postoperative follow-up and long-term functional evaluations including clinical symptoms and pulmonary function are still needed.

Keywords: congenital tracheal stenosis; dysphagia; infant; pulmonary function; slide tracheoplasty.

MeSH terms

Body Weight
Constriction, Pathologic
Humans
Infant
Plastic Surgery Procedures* / adverse effects
Plastic Surgery Procedures* / methods
Retrospective Studies
Trachea* / abnormalities
Trachea* / diagnostic imaging
Trachea* / surgery
Tracheal Stenosis / congenital
Treatment Outcome

Supplementary concepts

Congenital tracheal stenosis
Tracheal agenesis