Aortopexy in infants and children--long-term follow-up in twenty patients.
BACKGROUND
Aortopexy has become an established surgical procedure for the treatment of tracheomalacia (TM) in infants and children. The aim of the present study was to evaluate the clinical outcome and respiratory function after aortopexy in the long term.


METHODS
Between 1992 and 2006, 20 patients (6 female, 14 male) with TM were treated by bronchoscopically monitored pexis of the aorta via a right anterior thoracotomy. Patient age ranged from 4 months to 11 years (mean: 29 months). Five infants had previous surgery of esophageal atresia or tracheo-esophageal fistulae, and five other patients were operated on for gastroesophageal reflux. Postoperative tidal expiratory flow (TEF25%) was compared to age-related values.


RESULTS
Mean follow-up was 7.8 years (range: 13 months to 10.7 years). There was no early or late mortality. Most patients (n = 16) showed immediate and permanent relief of symptoms. Compared to corresponding age groups, median TEF25% was slightly but not significantly decreased after aortopexy (p = 0.15). In one patient a re-aortopexy was necessary. Another patient experienced recurrent tracheo-esophageal fistula 3 years after aortopexy.


CONCLUSIONS
The bronchoscopically guided aortopexy is an efficient and simple method in the surgical treatment of TM in infants and children. The follow-up data in this series of 20 patients showed improvement of respiratory function and permanent relief of symptoms in the long term.
Abdel-Rahman
Ulf
U
Department of Thoracic and Cardiovascular Surgery, Theodor-Stern-Kai 7, Johann Wolfgang Goethe-University, D-60590 Frankfurt/Main, Germany. abdel-rahman@em.uni-frankfurt.de
Simon
Andreas
A
Ahrens
Peter
P
Heller
Klaus
K
Moritz
Anton
A
Fieguth
Hans-Gerd
HG
D001011:Aorta / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005540:Forced Expiratory Flow Rates; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods*; D014133:Tracheal Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome