Hao Chen1, Guocheng Shi1, Limin Zhu1, Shunmin Wang1, Zhaohui Lu1, Zhiwei Xu2. 1. Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 2. Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Electronic address: xuzhiwei_scmc@yeah.net.
Abstract
BACKGROUND: This study was intended to determine the intermediate-term outcomes after slide tracheoplasty (STP) in patients with ring-sling complex. METHODS: All children undergoing STP between 2009 and 2018 were included. The patients' baseline characteristics, perioperative management details, and follow-up evaluations were reviewed retrospectively. RESULTS: Median age was 1.2 years (range, 2 months to 9.2 years). Seventy-eight patients had additional cardiovascular anomalies and 7 had unilateral pulmonary hypoplasia. Carina involved in the stenotic lesion was present in 42 patients and carinal compression occurred in 58. Twenty-five (21.6%) patients had a stenosis extending into the main bronchus. Type 2, typically having aberrant tracheobronchial patterns, accounted for nearly two-thirds of the patients according to Wells' classification. There were 7 in-hospital deaths and 8 late deaths. Median follow-up was 2.1 years (range, 1.2 months to 9.2 years). Type 2B patients had a higher incidence of malacia and restenosis. In multivariate analysis, the additional cardiovascular anomaly was significantly associated with postoperative tracheomalacia (P = .037). Carinal stenosis (P = .034) was significantly associated with recurrent stenosis. Bronchial stenosis with concomitant carinal stenosis and compression was significantly associated with postoperative tracheomalacia, restenosis, and mortality (for all comparisons, P < .001). CONCLUSIONS: Intermediate outcomes of STP in patients with ring-sling complex is satisfactory. Type 2B is a heterogenous subset patients with more severe tracheobronchial anomalies who will benefit from recognition preoperatively and close surveillance postoperatively.
BACKGROUND: This study was intended to determine the intermediate-term outcomes after slide tracheoplasty (STP) in patients with ring-sling complex. METHODS: All children undergoing STP between 2009 and 2018 were included. The patients' baseline characteristics, perioperative management details, and follow-up evaluations were reviewed retrospectively. RESULTS: Median age was 1.2 years (range, 2 months to 9.2 years). Seventy-eight patients had additional cardiovascular anomalies and 7 had unilateral pulmonary hypoplasia. Carina involved in the stenotic lesion was present in 42 patients and carinal compression occurred in 58. Twenty-five (21.6%) patients had a stenosis extending into the main bronchus. Type 2, typically having aberrant tracheobronchial patterns, accounted for nearly two-thirds of the patients according to Wells' classification. There were 7 in-hospital deaths and 8 late deaths. Median follow-up was 2.1 years (range, 1.2 months to 9.2 years). Type 2B patients had a higher incidence of malacia and restenosis. In multivariate analysis, the additional cardiovascular anomaly was significantly associated with postoperative tracheomalacia (P = .037). Carinal stenosis (P = .034) was significantly associated with recurrent stenosis. Bronchial stenosis with concomitant carinal stenosis and compression was significantly associated with postoperative tracheomalacia, restenosis, and mortality (for all comparisons, P < .001). CONCLUSIONS: Intermediate outcomes of STP in patients with ring-sling complex is satisfactory. Type 2B is a heterogenous subset patients with more severe tracheobronchial anomalies who will benefit from recognition preoperatively and close surveillance postoperatively.