One slide fits all: the versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children.
OBJECTIVE
This study describes results of tracheal reconstruction in children with slide tracheoplasty with cardiopulmonary bypass and identifies predictors for adverse outcomes.


METHODS
Preoperative characteristics, operative variables, and outcome measures were collected for children undergoing slide tracheoplasty with cardiopulmonary bypass between April 2001 and October 2009. Predictors of worse outcomes were identified by bivariate analysis. Multiple regression analysis was performed for predictors of prolonged hospital stay.


RESULTS
Cohort included 80 patients (median age, 8.7 months; 7 days-21 years). Forty-eight patients had associated cardiac or great vessel anomalies; 24 had simultaneous repair of cardiovascular anomaly at tracheal reconstruction. Fifty (63%) were extubated within 48 hours after operation. Median stay was 18.5 days (range, 7-119 days). Twenty-three patients (29%) required significant airway reintervention during median follow-up of 12 months (range, 4 months-7.8 years). There were 4 deaths, 2 early and 2 late. In bivariate analysis, age (P = .017), cardiopulmonary bypass duration (P = .025), and duration of mechanical ventilation (P < .05) were associated with mortality; duration of postoperative mechanical ventilation was associated with need for significant airway reintervention (P = .009). Multiple regression analysis indicated preoperative ventilatory support (P < .001), longer cardiopulmonary bypass (P = .002), previous airway operation (P = .01), and need for significant airway reintervention (P < .001) as predictors of longer hospital stay.


CONCLUSIONS
Slide tracheoplasty with cardiopulmonary bypass can be performed with low mortality in a diverse pediatric population. This technique minimizes need for early significant airway reintervention in most cases.
Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. peter.manning@cchmc.org
Peter B
PB
Manning
Michael J
MJ
Rutter
Asher
A
Lisec
Resmi
R
Gupta
Bradley S
BS
Marino
D000293:Adolescent; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009820:Ohio; D012044:Regression Analysis; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications / Q000601:surgery; D055815:Young Adult