Abstract
Objectives:
Over the past decade, thoracic slide tracheoplasty (TST) has become the principal operation in the management of congenital tracheal stenosis. The purpose of this report is to (1) describe our experience with revision TST following unsuccessful prior tracheal reconstruction and (2) compare our outcomes with primary TST.
Methods:
Patients undergoing TST on cardiopulmonary bypass between January 2005 and 2014 were reviewed. Patients with a history of prior airway surgery were extracted for further analysis. Preoperative patient variables and postoperative outcomes were evaluated.
Results:
A total of 108 patients were reviewed over the study period. Twenty-two revision patients (20 referrals, 2 primary patients) met inclusion criteria. Eighteen patients had a history of complete tracheal rings and 4 patients had cartilaginous deficiency. A total of 35 tracheoplasties (rib graft = 6; slide tracheoplasty = 5; pericardial patch = 4; homograft = 3;resection = 1; cricoid split = 1; combined tracheal reconstruction = 15) had been performed prior to revision TST. Following revision TST, additional endoscopic interventions were required in 5 patients (23%). Twelve balloon dilations (average 2.4 per child) and 4 endoscopic stent placements were performed in these 5 patients. The majority (68%) of children required <48 hours of ventilator support following revision. There was one nonsurgical postoperative mortality.
Conclusions:
Despite some differences in the postoperative management when compared to nonrevision cases, revision TST can be successfully performed after prior tracheal reconstruction with good postoperative outcomes.
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