Aortopexy in severe tracheal instability: short-term and long-term outcome in 29 infants and children.
BACKGROUND
Tracheal instability is a hazardous situation after operation for esophageal atresia. In cases with life-threatening apneas, aortopexy is a therapeutic option. To assess efficacy, short-term and long-term outcome was analyzed retrospectively.


METHODS
Between 1985 and 2000, 29 patients (age, 1.5 months to 5.2 years) were operated on. A flaccid trachea after operation for esophageal atresia was the cause for life-threatening apneas in 27, and there was external vascular compression in 2 patients. The operative procedure consisted of ventropexy of the aortic arch to the sternum and ventral thoracic wall.


RESULTS
There was neither early nor late mortality. A reversible lesion of the phrenic nerve was observed in 2 patients, a pneumothorax in 3, and secondary wound healing in 1. In all but 1 patient symptoms improved markedly or disappeared within days or within the first 3 months postoperatively. An increased susceptibility to respiratory infections was observed in long-term follow-up.


CONCLUSIONS
Aortopexy can be performed with no mortality and low morbidity. Aortopexy is effective to prevent further life-threatening apneas, but does not prevent an increased susceptibility to respiratory infections.
Vazquez-Jimenez
J F
JF
Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Germany. jvazquez-jimenez@post.klinikum.rwth-aachen.de
Sachweh
J S
JS
Liakopoulos
O J
OJ
Hügel
W
W
Holzki
J
J
von Bernuth
G
G
Messmer
B J
BJ
D001013:Aorta, Thoracic / Q000601:surgery*; D001049:Apnea / Q000601:surgery*; D002675:Child, Preschool; D003238:Connective Tissue / Q000601:surgery; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D013249:Sternum / Q000601:surgery; D013536:Suture Techniques; D014133:Tracheal Diseases / Q000601:surgery*