Posterior tracheopexy for severe tracheomalacia

Abstract Purpose In severe tracheomalacia, aortopexy addresses anterior vascular compression, but does not directly address posterior membranous tracheal intrusion. We review patient outcomes of posterior tracheopexy for tracheomalacia with posterior intrusion to determine if there were resolution o...

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Bibliographic Details
Published in:Journal of pediatric surgery 2017-06, Vol.52 (6), p.951-955
Main Authors: Shieh, Hester F, Smithers, C. Jason, Hamilton, Thomas E, Zurakowski, David, Rhein, Lawrence M, Manfredi, Michael A, Baird, Christopher W, Jennings, Russell W
Format: Article
Language:English
Subjects:
Aortopexy
Bronchoscopy
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Male
Pediatrics
Posterior tracheopexy
Retrospective Studies
Severity of Illness Index
Surgery
Trachea - surgery
Tracheomalacia
Tracheomalacia - diagnosis
Tracheomalacia - surgery
Treatment Outcome
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Summary:Abstract Purpose In severe tracheomalacia, aortopexy addresses anterior vascular compression, but does not directly address posterior membranous tracheal intrusion. We review patient outcomes of posterior tracheopexy for tracheomalacia with posterior intrusion to determine if there were resolution of clinical symptoms and bronchoscopic evidence of improvement in airway collapse. Methods All patients who underwent posterior tracheopexy from October 2012 to March 2016 were retrospectively reviewed. Clinical symptoms, tracheomalacia scores based on standardized dynamic airway evaluation by anatomical region, and persistent airway intrusion were collected. Data were analyzed by Wald and Wilcoxon signed-ranks tests. Results 98 patients (51% male) underwent posterior tracheopexy at median age 15 months (IQR 6–33 months). Median follow up was 5 months (range 0.25–36 months). There were statistically significant improvements in clinical symptoms postoperatively, including cough, noisy breathing, prolonged and recurrent respiratory infections, transient respiratory distress requiring positive pressure, oxygen dependence, blue spells, and apparent life-threatening events (p < 0.001), as well as ventilator dependence (p = 0.04). Tracheomalacia scores on bronchoscopy improved significantly in all regions of the trachea and bronchi (p < 0.001). 9.2% had persistent airway intrusion requiring reoperation, usually with aortopexy. Conclusions: Posterior tracheopexy is effective in treating severe tracheomalacia with significant improvements in clinical symptoms and degree of airway collapse on bronchoscopy. Level of Evidence Level III Treatment Study.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2017.03.018