TY - JOUR
T1 - Posterior tracheopexy for severe tracheomalacia
AU - Shieh, Hester F.
AU - Smithers, C. Jason
AU - Hamilton, Thomas E.
AU - Zurakowski, David
AU - Rhein, Lawrence M.
AU - Manfredi, Michael A.
AU - Baird, Christopher W.
AU - Jennings, Russell W.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/6
Y1 - 2017/6
N2 - Purpose In severe tracheomalacia, aortopexy addresses anterior vascular compression, but does not directly address posterior membranous tracheal intrusion. We review patient outcomes of posterior tracheopexy for tracheomalacia with posterior intrusion to determine if there were resolution of clinical symptoms and bronchoscopic evidence of improvement in airway collapse. Methods All patients who underwent posterior tracheopexy from October 2012 to March 2016 were retrospectively reviewed. Clinical symptoms, tracheomalacia scores based on standardized dynamic airway evaluation by anatomical region, and persistent airway intrusion were collected. Data were analyzed by Wald and Wilcoxon signed-ranks tests. Results 98 patients (51% male) underwent posterior tracheopexy at a median age of 15 months (IQR 6–33 months). Median follow-up was 5 months (range 0.25–36 months). There were statistically significant improvements in clinical symptoms postoperatively, including cough, noisy breathing, prolonged and recurrent respiratory infections, transient respiratory distress requiring positive pressure, oxygen dependence, blue spells, and apparent life-threatening events (p < 0.001), as well as ventilator dependence (p = 0.04). Tracheomalacia scores on bronchoscopy improved significantly in all regions of the trachea and bronchi (p < 0.001). 9.2% had persistent airway intrusion requiring reoperation, usually with aortopexy. Conclusions Posterior tracheopexy is effective in treating severe tracheomalacia with significant improvements in clinical symptoms and degree of airway collapse on bronchoscopy. Level of evidence Level III, treatment study.
AB - Purpose In severe tracheomalacia, aortopexy addresses anterior vascular compression, but does not directly address posterior membranous tracheal intrusion. We review patient outcomes of posterior tracheopexy for tracheomalacia with posterior intrusion to determine if there were resolution of clinical symptoms and bronchoscopic evidence of improvement in airway collapse. Methods All patients who underwent posterior tracheopexy from October 2012 to March 2016 were retrospectively reviewed. Clinical symptoms, tracheomalacia scores based on standardized dynamic airway evaluation by anatomical region, and persistent airway intrusion were collected. Data were analyzed by Wald and Wilcoxon signed-ranks tests. Results 98 patients (51% male) underwent posterior tracheopexy at a median age of 15 months (IQR 6–33 months). Median follow-up was 5 months (range 0.25–36 months). There were statistically significant improvements in clinical symptoms postoperatively, including cough, noisy breathing, prolonged and recurrent respiratory infections, transient respiratory distress requiring positive pressure, oxygen dependence, blue spells, and apparent life-threatening events (p < 0.001), as well as ventilator dependence (p = 0.04). Tracheomalacia scores on bronchoscopy improved significantly in all regions of the trachea and bronchi (p < 0.001). 9.2% had persistent airway intrusion requiring reoperation, usually with aortopexy. Conclusions Posterior tracheopexy is effective in treating severe tracheomalacia with significant improvements in clinical symptoms and degree of airway collapse on bronchoscopy. Level of evidence Level III, treatment study.
KW - Aortopexy
KW - Posterior tracheopexy
KW - Tracheomalacia
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U2 - 10.1016/j.jpedsurg.2017.03.018
DO - 10.1016/j.jpedsurg.2017.03.018
M3 - Article
C2 - 28385426
AN - SCOPUS:85017358154
SN - 0022-3468
VL - 52
SP - 951
EP - 955
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 6
ER -