Tracheal surgery in children: outcome of a 12-year survey

Arcieri, Luigi; Pak, Vitali; Poli, Vincenzo; Baggi, Roberto; Serio, Paola; Assanta, Nadia; Moschetti, Riccardo; Noccioli, Bruno; Masi, Salvatore; Mirabile, Lorenzo; Murzi, Bruno

doi:10.1093/icvts/ivx390

Cited by 11 publications

(19 citation statements)

References 23 publications

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“…The literature mainly cites cases of congenital tracheal disorders in children, which are usually treated with surgical interventions such as dilatation, slide tracheoplasty, 7 costal cartilage tracheoplasty, pericardial patch tracheoplasty, and tracheal autograft, whereas tracheal resection is a viable option in cases of short segments of stenosis (<8-10 rings of cartilage). 20 In our case, the standard method of slide tracheoplasty could not be performed because of severe tracheal wall thickening after repeated stenting. 7 As a result, the trachea had to be resected by 6 cm, which resulted in death after the surgery.…”

Section: Discussionmentioning

confidence: 74%

Effect of resected length in reconstructive surgery for tracheobronchial injury

Vũ

Khanh

Nguyễn

et al. 2019

Asian Cardiovasc Thorac Ann

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Background Mechanical injury to the trachea and bronchi may cause mild to severe stenosis requiring surgical intervention for reconstructing the damaged trachea. The location, length, and cause of injury are important factors affecting the surgical outcome. Method We conducted a retrospective study to evaluate the results of reconstructive surgery on noncancerous tracheobronchial lesions in 75 patients aged 5–55 years who had undergone reconstructive tracheobronchial surgery in our hospital from 2009 to 2018. Results The causes of tracheobronchial injury included blunt trauma in 38 patients, sharp penetrating trauma in 24, a postintubation lesion in 6, a post-tracheotomy lesion in 3, tuberculosis in 3, and an adult congenital lesion in one. In 59 cases of a lesion in the trachea, the length of missing segment before reconnection was 1–2 cm in 6 cases, 3 cm in 22, 4 cm in 18, 5 cm in 13, and >5.5 cm in 1 case. The length of the resected segment was <5.5 cm in all survivors, whereas one death occurred when the resected length was approximately 6 cm. Conclusions The length of the resected segment and precision of the surgery are crucial for determining the outcome of surgery.

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Section: Discussionmentioning

confidence: 74%

Effect of resected length in reconstructive surgery for tracheobronchial injury

Vũ

Khanh

Nguyễn

et al. 2019

Asian Cardiovasc Thorac Ann

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“…While some of the difference in outcome reported between single-center studies and larger multiinstitutional datasets is due to publication bias 1 additional explanation is that consolidation to centers of excellence may have improved outcomes compared to nationwide results. 17,18 Another factor that could account for the higher mortality seen in this paper as compared to other single-center reports is that this multicenter database review did not account for all patients undergoing congenital cardiac surgery. Commonly performed cardiac operations were selected (Supplement 1) to allow matching based on similar cardiac operations.…”

Section: Commentmentioning

confidence: 88%

Risk of Pediatric Cardiac Surgery Increased in Patients Undergoing Tracheal Surgery During the Same Hospitalization

Riggs

Wells

Zafar

et al. 2021

World J Pediatr Congenit Heart Surg

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Background The impact of complex tracheal surgery (TS) on outcomes of children undergoing cardiac surgery has rarely been investigated in large national databases and could impact anticipated outcomes in those patients. Methods The Pediatric Health Information System database was reviewed from January 1, 2005 to December 31, 2014, for pediatric (<18 years) patients undergoing select cardiac surgical procedures using International Classification of Disease-9 procedural coding. Patients were divided based upon having TS (excluding tracheostomy) during the same hospitalization. Patients with tracheal and cardiac surgeries (CHS + TS) were propensity matched in a 1 : 2 fashion to patients undergoing isolated cardiac surgeries without TS (CHS) based upon cardiac procedure(s), age at surgery, gender, and discharge year. Hospital mortality and other outcomes were compared between the 2 matched groups. Results The 283 CHS + TS patients were similar to the 566 CHS patients in gender, race, age, cardiac procedures, and presence of chromosomal abnormalities, all P > .05. Hospital mortality was 13.8% ( n = 39) for CHS + TS and 5.8% ( n = 33) for CHS patients with an unadjusted 2.58 hazard ratio of death (95% confidence interval: 1.59-4.20; P < .001). CHS + TS was also associated with a greater length of stay (63 days vs 12 days), a higher cost per hospitalization ($322 402 vs $80 273), and more readmissions (64.3% [ n = 182] vs 41.8% [ n = 243]), all P < .001. Conclusions Patients undergoing cardiac and TS in the same hospitalization are at greater risk of in-hospital mortality than patients undergoing similar cardiac surgeries alone and incur higher resource utilization thereafter. The increased risk of mortality is currently underappreciated, but it is important to recognize when discussing expectations with families and providers.

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“…3,8,9,11,13,18,19 Stenting aims to recover the airway architecture, giving support to the structure, and to maintain the permeability of the trachea. 30 In our clinical research experience with airway stents in animals, we have tested numerous stents such as steel stain, nitinol, drugeluting, and biodegradable stents. Each stent has pros and cons, but complications are always present.…”

Section: Discussionmentioning

confidence: 99%

“…Airway malacia is a benign pathology that presents many difficulties for its management. Talking about pediatric tracheomalacia, the challenge is still greater due to the reduced diameter of the respiratory tree and the rapid growth of the patient 30 . The study presented is a research on pathological dogs of three different small/toy breeds, with a reduced tracheal diameter.…”

Section: Discussionmentioning

confidence: 99%

A new airway spiral stent designed to maintain airway architecture with an atraumatic removal after full epithelization—Research of feasibility and viability in canine patients with tracheomalacia

Serrano‐Casorran

López-Mínguez

Rodriguez‐Zapater

et al. 2020

Pediatric Pulmonology

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Objective Surgical management of tracheomalacia is a challenge, with current treatments still presenting numerous complications. In the field of veterinary medicine, this same pathology is present in a significant number of dogs. For this reason, we present an experimental clinical trial performed on canines with tracheobronchomalacia, using a new atraumatic removable tracheal spiral stent (SS). Both implantation procedure and clinical improvement have been analyzed in this study. Methods In this study, four small dogs, a mean weight of 4.89 kg and body condition scores IV‐V, were included. SS was implanted by two different surgical approaches. Image and clinical follow‐up have been performed during 90 days. Symptoms were evaluated from 1 to 10 every week. Results This study achieved 100% technical and clinical success. Median tracheal diameters were as follows: cervical 10.85 (3.3), inlet 7.75 (2.1), and carina 7.75 (1.9) mm, and length was 77.5 (26) mm. A 12 × 10 × 100‐mm SS was implanted in all cases. Goose honk cough punctuation improved from 8 to 1; also, there were important changes in exercise intolerance, a mean weight loss of 8.76%. The values of modified Karnofsky scale varied from 50 (20) before surgery to 90 (10) after 30 days of surgery. Neither granuloma tissue nor fractures of the prosthesis was observed. Conclusion The results in dogs are promising, and a new therapeutic alternative seems to be available for veterinarian field. The similarity of this disease between dogs and newborns suggests that this SS design can also be useful for human trials.

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Tracheal surgery in children: outcome of a 12-year survey

Cited by 11 publications

References 23 publications

Effect of resected length in reconstructive surgery for tracheobronchial injury

Effect of resected length in reconstructive surgery for tracheobronchial injury

Risk of Pediatric Cardiac Surgery Increased in Patients Undergoing Tracheal Surgery During the Same Hospitalization

A new airway spiral stent designed to maintain airway architecture with an atraumatic removal after full epithelization—Research of feasibility and viability in canine patients with tracheomalacia

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