Intermediate-term results of the free tracheal autograft for long segment congenital tracheal stenosis.
OBJECTIVE
Since 1996 a new procedure--the free tracheal autograft--has been used to repair long segment congenital tracheal stenosis (LSCTS). The purpose of this report is to examine the intermediate-term results of that technique.


METHODS
Between January 1996 and July 1999, 10 infants underwent repair of LSCTS using a free tracheal autograft. Age ranged from 10 days to 23 months (mean age, 6.6 months). Six infants had a pulmonary artery (PA) sling; 5 had intracardiac anomalies. On cardiopulmonary bypass (CPB) the trachea was incised anteriorly through the area of stenosis. The midportion of the stenotic trachea was excised, and an end-to-end anastomosis was made posteriorly. The excised tracheal segment was trimmed and sutured in place anteriorly as a free autograft. In 5 patients the autograft was not long enough, and the upper portion of the tracheal opening was patched with pericardium.


RESULTS
There was 1 death 26 days postoperatively in a child that had simultaneous repair of tetralogy of Fallot and required extracorporeal membrane oxygenation postoperatively for cardiac failure. The other 9 children are alive and well at 2 to 44 months postoperatively (mean follow-up, 24 months). One child had autograft dehiscence and required replacement of the autograft with an aortic homograft. Two children have tracheostomies at 6 and 36 months postoperatively. All children have had serial postoperative bronchoscopic examinations. Most recent bronchoscopies have shown widely patent tracheal lumina in all survivors.


CONCLUSIONS
Intermediate-term follow-up of children with a free tracheal autograft continues to support our use of this technique as our procedure of choice for infants with LSCTS.
Backer
C L
CL
Northwestern University Medical School, and the Department of Surgery, The Children's Memorial Hospital, Chicago, Illinois 60614, USA.
Mavroudis
C
C
Dunham
M E
ME
Holinger
L
L
D000015:Abnormalities, Multiple; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D014132:Trachea / Q000637:transplantation*; D014135:Tracheal Stenosis / Q000151:congenital* / Q000601:surgery*; D014182:Transplantation, Autologous / Q000379:methods