The role of posterior aortopexy in the treatment of left mainstem bronchus compression

Arcieri, Luigi; Serio, Paola; Nenna, Raffaella; Maurizio, Marco Di; Baggi, Roberto; Assanta, Nadia; Moschetti, Riccardo; Noccioli, Bruno; Mirabile, Lorenzo; Murzi, Bruno

doi:10.1093/icvts/ivw209

Cited by 24 publications

(30 citation statements)

References 21 publications

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“…3 In their series of 18 patients, Arcieri et al reported associated malformations in 16 children, which included CHDs, oesophageal atresia, and trachea-oesophageal fistula. 4 Our patient had a structurally normal heart, but had associated pectus excavatum.…”

Section: Discussionmentioning

confidence: 69%

“…Symptoms may sometimes persist after aortopexy, due to secondary bronchomalacia, and may require bronchial stenting for symptom relief. 4 Arcieri et al reported residual bronchomalacia in 44% of their cases. 4 Repeat bronchoscopy at one-year follow-up revealed normal caliber of bronchus with no residual malacia in our patient.…”

Section: Discussionmentioning

confidence: 92%

“…This has been described as an effective mode of management by most previous authors too. 2,[4][5][6] Speggiorin and his colleagues adopted a combined approach of Nuss procedure and aortopexy in two cases, where pectus excavatum was associated. However, we decided to do aortopexy alone initially, as there was no significant compression of the trachea and heart and had planned to consider Nuss procedure only if child continued to remain symptomatic.…”

Section: Discussionmentioning

confidence: 99%

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Aortopexy – an effective strategy for relief of left main bronchus compression

2020

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Aortopexy – an effective strategy for relief of left main bronchus compression

2020

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“…Others have tried posterior aortopexy—suturing the descending aorta to the thoracic vertebrae—to address left mainstem bronchomalacia. Unfortunately, in the largest study of this technique, eight out of 18 of children were found to have residual severe left mainstem bronchomalacia requiring a tracheostomy (n = 1) or placement of internal stents (n = 7) …”

Section: Discussionmentioning

confidence: 99%

“…study of this technique, eight out of 18 of children were found to have residual severe left mainstem bronchomalacia requiring a tracheostomy (n = 1) or placement of internal stents (n = 7). 23 Jennings has pioneered tracheobronchopexy, 6 in which the posterior (membranous) trachea is sutured to the anterior spinal ligament and/or the anterior (cartilaginous) trachea and/or bronchi are sutured to the sternum. In a recent case series, authors report no early or late deaths.…”

Section: Discussionmentioning

confidence: 99%

3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

et al. 2019

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Objective To report the clinical safety and efficacy of 3D-printed, patient-specific, bioresorbable airway splints in a cohort of critically ill children with severe tracheobronchomalacia. Methods From 2012–2018, 15 subjects received 29 splints on their trachea, right and/or left mainstem bronchi. The median age at implantation was eight months (range, 3–25 months). Nine children were female. Five subjects had a history of ECMO (extra-corporeal membrane oxygenation), and eleven required continuous sedation, six of which required paralytics to maintain adequate ventilation. Thirteen were chronically hospitalized, unable to be discharged, and seven were hospitalized their entire lives. At the time of splint implantation, one subject required ECMO, one required positive airway pressure, and 13 subjects were tracheostomy and ventilator dependent, requiring a median positive end-expiratory pressure (PEEP) of 14 cmH2O (range, 6–20 cmH20). Outcomes collected included level of respiratory support, disposition, and splint-related complications. Results At the time of discharge from our institution, at a median of 28 days’ post-implantation (range, 10–56 days), the subject on ECMO was weaned from extracorporeal support, and the subjects who were ventilated via tracheostomy had a median change in PEEP (discharge – baseline) of −2.5 cmH2O (range, −15 to 2 cmH2O, p=0.022). At median follow-up of 8.5 months (range, 0.3–77 months), all but one of the 12 surviving subjects lives at home. Of the 11 survivors who were tracheostomy dependent pre-op, one is decannulated, one uses a speaking valve, six use a ventilator exclusively at night, and three remain ventilator dependent. Conclusion This case series demonstrates the initial clinical efficacy of the 3D-printed bioresorbable airway splint device in a cohort of critically ill children with severe tracheobronchomalacia.

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