Risk Stratification of Slide Tracheoplasty for Pediatric Airway Stenosis

Beeman, Arun; Ramaswamy, Madhavan; Chippington, Samantha; Wallis, Collin; Hayden, M.; Hewitt, Richard; Muthialu, Nagarajan

doi:10.1016/j.athoracsur.2021.04.004

Cited by 11 publications

(17 citation statements)

References 19 publications

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Section: Resultsmentioning

confidence: 99%

“…13 In patients requiring pre-operative ECMO, the risk in our systematic review was found to be 1.26-fold higher compared to our non-ECMO subset, in contrast to other individual case series reported rates of 2.53 to 5.40 (Figure 2). 9,17 High mortality in these patients can be attributed to pre-operative conditions, such as need for ventilation, severity of disease, and associated cardiovascular anomalies.…”

Section: Discussionmentioning

confidence: 99%

“…Inclusion can allow for more risk stratification assessment from all specialties, especially otolaryngology, in treatment and surveillance timelines leading to better quality and survival outcomes. 9 The primary cause of post-operative complications, such as need for tracheostomy, have been associated with persistent tracheomalacia or cardiovascular issues, further illustrating that complications are not primarily airway related. 9, 13 Wertz et al 10 found that pre-operative tracheomalacia and bronchomalacia was not associated with the need for tracheostomy post-operatively.…”

Section: Discussionmentioning

confidence: 99%

“…Once evaluated, each study was reviewed by 3 authors to confirm presence of specific pre-operative ECMO and cardiac information, which resulted in the inclusion of 7 studies for the systematic review and 5 studies for the hazard ratio analysis (Figure 1). [9][10][11][12][13][14][15] Studies for inclusion underwent quality assessment using standardized MINOR criteria tools. This tool was chosen due to its inherent design in evaluating surgical studies for rare diagnoses without a control group.…”

Section: Literature Searchmentioning

confidence: 99%

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Systematic Review of Slide Tracheoplasty Outcomes

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Behzadpour

Leonard

et al. 2022

Ann Otol Rhinol Laryngol

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Objective: To identify factors predicting success in slide tracheoplasty surgery at a regional children’s hospital and compare with available published literature. Measures: Retrospective chart review comparing demographics (age, weight) and clinical (operative and hospital course, need for additional airway intervention) factors experienced with slide tracheoplasty. Findings were compared with a systematic review of published literature. Results: Of the 16 tracheal stenosis patients in our cohort, 13 (81.3%) presented with an additional congenital or cardiovascular anomaly. When adjusted for cardiovascular anomalies, congenital tracheal stenosis patients had a mean age of 5.2 months (range 6 days-17 months), mean weight of 5.04 kg, and average ICU and hospital length of stay of 31.5 and 36.0 days, respectively. Tracheostomy was required for 4 patients and no early deaths were recorded. Of the 391 children in the grouped cohort, mean age and weight was older at 7.67 months and larger at 5.70 kg. Length of stay in both ICU and overall hospital course was 31.6 and 43.5 days, respectively. Mortality etiology for 44 patients was reported: 17 (38.6%) cardiac-related and 28 (63.6%) late mortalities. Our overall calculated mortality risk of 1.26 ( P < .05) was lower than reported ratios of 2.0+. Conclusion: Despite the numerous institutional studies involving tracheal stenosis, mortality and surgical challenges remain high. Future studies with the inclusion of specific perioperative data can prove to further evaluate correlations between presentation characteristics and mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

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Systematic Review of Slide Tracheoplasty Outcomes

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Behzadpour

Leonard

et al. 2022

Ann Otol Rhinol Laryngol

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“…Entsprechend dem komplexen Patientengut wird eine Komplikationsrate von 47 % beschrieben. Des Weiteren können postoperativ Ballondilatationen (23 %) oder Stent-Implantationen (19 %) notwendig sein, bis ein dauerhafter Erfolg erzielt wird [27].…”

Section: Slide Tracheoplastyunclassified

Pädiatrische Atemwegschirurgie: Indikationen und Techniken

et al. 2022

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ZusammenfassungIn der pädiatrischen Atemwegschirurgie sind zahlreiche anatomische Besonderheiten, spezifische Krankheitsbilder sowie spezielle Operationstechniken zu beachten. Auch an spezialisierten Zentren sind diese Eingriffe bei pädiatrischen Patienten eher selten. Ätiologisch handelt es sich meist um erworbene Stenosen als Folge von Frühgeburtlichkeit, Langzeitintubation oder -tracheotomie, welche typischerweise in Kindern mit zahlreichen Komorbiditäten auftreten. Kongenitale Fehlbildungen der Atemwege gehen häufig mit weiteren Malformationen einher, welche die erfolgreiche Behandlung zusätzlich erschweren. Voraussetzung zur Behandlung dieser Kinder sollte daher ein multidisziplinäres Team sein. An erfahrenen Zentren mit entsprechender Infrastruktur kann die chirurgische Behandlung dieser Kinder mit sehr guten Ergebnissen durchgeführt werden. So wird bei den meisten Patienten nach chirurgischer Behandlung eine sehr gute Lebensqualität ohne Notwendigkeit einer Langzeittracheostomie erreicht. Diese Übersichtsarbeit fasst die wichtigsten Indikationen, sowie die häufigsten Operationstechniken in der pädiatrischen Atemwegschirurgie zusammen.

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Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies

et al. 2023

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ObjectivesBronchial anomalies are rare but challenging conditions to treat in children, encompassing a variety of structural abnormalities that could compromise airway patency. This includes complete rings, absent cartilage, traumatic avulsions, bronchoesophageal fistulas, and cartilaginous sleeves. The objective of this study is to describe the characteristics and outcomes of a series of pediatric cases of bronchial anomalies that were treated by slide tracheobronchoplasty.MethodsThis is a single‐institution retrospective case series of pediatric patients with bronchial anomalies who underwent surgical treatment between February 2004 and April 2020. Data extracted from electronic medical records included patient demographics, comorbidities, and surgical outcomes.ResultsThere were a total of 29 patients included in the study, of which 14 had complete bronchial rings, 8 had absent bronchial rings, 4 had traumatic bronchial avulsions, 2 had bronchoesophageal fistulas, and one had a cartilaginous sleeve. Median follow‐up time was 13 months (with a range of 0.5–213 months). The overall mortality rate was 17.2% (5 patients), all of whom had complete bronchial rings. Patients with complete bronchial rings also had a higher rate of not only cardiac (85.7%) and pulmonary comorbidities (85.7%) but also secondary airway lesions (78.6%).ConclusionThis is the largest series to date describing surgical treatment for bronchial anomalies. Complete bronchial rings were the most common anomaly treated, followed by absent rings and trauma. Surgical treatment can be successful but mortality rates are higher in patients with complete bronchial rings, possibly due to higher rates of pulmonary and cardiac comorbidities.Level of Evidence4 Laryngoscope, 2023

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Risk Stratification of Slide Tracheoplasty for Pediatric Airway Stenosis

Cited by 11 publications

References 19 publications

Systematic Review of Slide Tracheoplasty Outcomes

Systematic Review of Slide Tracheoplasty Outcomes

Pädiatrische Atemwegschirurgie: Indikationen und Techniken

Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies

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