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| One Slide Fits All: The Versatility of Slide Tracheoplasty Utilizing Cardiopulmonary Bypass Support for Airway Reconstruction in Children |
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Peter B. Manning1, Michael J. Rutter2, Asher Lisec3, Bradley S. Marino3 1 Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 2 Otorhinolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 3 Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Objective: Distal tracheal reconstruction in children is commonly associated with significant mortality and morbidity. Slide tracheoplasty with cardiopulmonary bypass (CPB) support uses all native tissue allowing growth potential and results in a more stable airway, facilitating early extubation. The purpose of this study is to describe our results with this approach and identify predictors for adverse outcomes. Methods: Patients undergoing slide tracheoplasty with CPB from 4/01-8/09 were reviewed. Preoperative characteristics, operative variables, and outcome measures [mortality, total hospital length of stay (LOS), and significant airway reintervention (>1 endoscopic dilation, stenting, and/or tracheal re-operation)] were collected. Predictors of worse outcomes were identified using bivariate analysis. Multivariable modeling was performed for predictors of prolonged LOS. Results: The cohort included 76 patients (median age 8.7 months, 7d-20yrs); 71 (93%) had congenital tracheal lesions and 19 (25%) had prior tracheal operations. Length of tracheal pathology was <50%, 50-80%, and > 80% of the total tracheal length in 22, 35, and 19 patients respectively. 45 patients had associated cardiac or great vessel anomalies; 23 patients had simultaneous repair of a cardiovascular anomaly at the time of tracheal reconstruction. Median CPB time was 95 min (range 49-318) for the entire group and 86 min for tracheoplasty only. 47 (62%) patients were extubated within 48 hours of their operation. Median LOS was 19 days (range 7-119). 21 patients (28%) required significant airway reintervention during a median follow-up duration of 12 months (range 1m-7.8yrs). There were 4 deaths; 2 early and 2 late. In bivariate analysis, age (p=.015) and CPB duration (p=.029) were predictors of mortality, while duration of postoperative mechanical ventilation was associated with need for significant airway reintervention (p=.015). Multivariable analysis showed that preoperative ventilatory support (p<.001), longer CPB duration (p=.003), and the need for significant airway reintervention (p=.001) were predictors of longer LOS. Conclusion: Slide tracheoplasty with CPB may be performed with low mortality in a diverse population of pediatric patients including those with full-length congenital stenosis, acquired lesions, and reoperative tracheoplasty. Utilizing this technique minimizes the need for early significant airway reintervention in the majority of patients. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.