Tracheobronchial obstruction: follow-up study of 100 children treated with airway stenting

• Published in: European journal of cardio-thoracic surgery 2014-04, Vol.45 (4), p.e100-e109
• Main Authors: Serio, Paola, Fainardi, Valentina, Leone, Roberto, Baggi, Roberto, Grisotto, Laura, Biggeri, Annibale, Mirabile, Lorenzo
• Format: Article
• Language: English
• Subjects: Bronchial Diseases - surgery; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Postoperative Complications - etiology; Retrospective Studies; Stents; Thoracic Surgical Procedures - adverse effects; Thoracic Surgical Procedures - instrumentation; Thoracic Surgical Procedures - methods; Tracheal Stenosis - surgery; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezt626

OBJECTIVE We described a cohort of 100 children with a wide variety of airway obstruction who underwent stent positioning in the last 7 years. The study examined the outcomes of this treatment in the largest series of paediatric patients reported in the literature with special concern over safety and clinical effectiveness. METHODS We performed a retrospective analysis of 100 consecutive paediatric patients who underwent stent insertions between January 2005 and May 2012. Statistical analysis was performed and exact likelihood was used. RESULTS A total of 235 stents were placed for severe airway obstruction. One hundred and twelve silicone stents (cylinder, hourglass or Y-shaped), 120 metallic stents (covered Nitinol stents, expandable coronary and vascular stents) and 3 biodegradable polydioxanone (PDS) stents were used. Eighty patients presented clinical improvement after stent insertion, 17 were weaned off mechanical ventilation and 3 showed no significant clinical improvement [95% confidence interval (CI) 0.1-8.0%]. Complications were different according to stent type. In our cohort, no fatal stent-related complications have been observed. At follow-up (median 41.4 months, range 1.1-145.4) complete resolution was registered for 60 patients (66%; 95% CI 55-76%), 17 are still under treatment, 9 were lost to follow-up, 8 underwent surgery and 6 died of causes not stent related. CONCLUSION Airway stenting represents a conservative treatment before more invasive surgical procedures and can be very effective when performed in selected children and in specialized centres by physicians experienced in rigid and flexible bronchoscopy.