TY - JOUR
T1 - Great vessel anomalies and their impact on the surgical treatment of tracheobronchomalacia
AU - Svetanoff, Wendy Jo
AU - Zendejas, Benjamin
AU - Smithers, Charles J.
AU - Prabhu, Sanjay P.
AU - Baird, Christopher W.
AU - Jennings, Russell W.
AU - Hamilton, Thomas E.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/7
Y1 - 2020/7
N2 - Background: Tracheobronchial compression (TBC) from great vessel anomalies (GVA) can contribute to tracheobronchomalacia (TBM) symptoms. The frequency, impact on symptoms and optimal management of GVA in these patients, with or without a history of esophageal atresia (EA), are still unclear. Study design: Patients who underwent surgery for TBM/ TBC between 2001 and 2017 were reviewed. Demographics, type of GVA, and operative interventions were collected. The frequency and treatment modalities of GVA between EA and non-EA patients were compared. Results: Overall, 209 patients met criteria; 120 (57.4%) patients had at least one GVA, including double aortic arches (n = 4, 1.9%), right aortic arches (n = 14, 6.7%), aberrant right subclavian arteries (n = 15, 7.2%), and innominate artery compression (n = 71, 34.0%). Non-EA patients were more likely to have surgery later in life (29.5 months versus 16 months, p = 0.0002), double aortic arch (p = 0.0174), right aortic arch (p < 0.0001), and undergo vascular reconstruction concurrently with their airway procedure (25% vs 8.4%, p = 0.002). Vessel reconstruction was performed in 25 patients; six required cardiac bypass. Conclusion: The frequency of GVA in patients with symptomatic airway collapse is substantial. Multidisciplinary evaluation is imperative for operative planning as many require complex reconstruction and collaboration with cardiac surgery, particularly patients without a history of EA. Level of evidence: Level III.
AB - Background: Tracheobronchial compression (TBC) from great vessel anomalies (GVA) can contribute to tracheobronchomalacia (TBM) symptoms. The frequency, impact on symptoms and optimal management of GVA in these patients, with or without a history of esophageal atresia (EA), are still unclear. Study design: Patients who underwent surgery for TBM/ TBC between 2001 and 2017 were reviewed. Demographics, type of GVA, and operative interventions were collected. The frequency and treatment modalities of GVA between EA and non-EA patients were compared. Results: Overall, 209 patients met criteria; 120 (57.4%) patients had at least one GVA, including double aortic arches (n = 4, 1.9%), right aortic arches (n = 14, 6.7%), aberrant right subclavian arteries (n = 15, 7.2%), and innominate artery compression (n = 71, 34.0%). Non-EA patients were more likely to have surgery later in life (29.5 months versus 16 months, p = 0.0002), double aortic arch (p = 0.0174), right aortic arch (p < 0.0001), and undergo vascular reconstruction concurrently with their airway procedure (25% vs 8.4%, p = 0.002). Vessel reconstruction was performed in 25 patients; six required cardiac bypass. Conclusion: The frequency of GVA in patients with symptomatic airway collapse is substantial. Multidisciplinary evaluation is imperative for operative planning as many require complex reconstruction and collaboration with cardiac surgery, particularly patients without a history of EA. Level of evidence: Level III.
KW - Aortic arch anomalies
KW - Esophageal atresia
KW - Great vessel anomalies
KW - Tracheobronchial compression (TBC)
KW - Tracheobronchomalacia (TBM)
KW - Tracheopexy
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U2 - 10.1016/j.jpedsurg.2019.08.001
DO - 10.1016/j.jpedsurg.2019.08.001
M3 - Article
C2 - 31422856
AN - SCOPUS:85070536471
SN - 0022-3468
VL - 55
SP - 1302
EP - 1308
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 7
ER -