title: Long-term follow-up of tracheoplasty using autologous pericardial patch and strips of costal cartilage.
abstract: OBJECTIVE
  To evaluate long-term results of tracheoplasty using autologous pericardial patch and strips of costal cartilage for relieving severe long-segment tracheal stenosis.
  
  
  METHODS
  Data were collected retrospectively by clinical chart review. Between 1995 and 2013, 21 patients underwent tracheoplasty. Follow-up was performed by outpatient chart review; otherwise, referring physicians and parents were contacted and asked to fill in a questionnaire.
  
  
  RESULTS
  Median age at the time of operation was 0.9 (range 0.5-44) years. Aetiology of tracheal stenosis was double aortic arch in 9 patients, right arch with a left ductus in 3, innominate artery compression in 1 patient, complete tracheal rings in 7, 3 of whom with pulmonary artery sling and 2 with agenesis of one lung, and other causes in 1 patient. Previous surgery was performed in 6 (29%) patients. Patch tracheoplasty was performed using autologous pericardial patch and external stenting using costal cartilage. Major complications were mediastinitis and patch dehiscence in 2 patients, 2 patients needed tracheal cannula and 1 patient had stent implantation. Three (14%) patients died in the late postoperative period: 1 patient died of sepsis, 1 had patch dehiscence and 1 erosion of tracheal stent and consequently intractable bleeding. Follow-up was 6.1±2.7 years (0.75-10 years). At follow-up, 2 (11%) patients were still symptomatic, 4 (22%) had occasionally mild symptoms and 12 (67%) were free of symptoms.
  
  
  CONCLUSIONS
  Treatment for severe tracheal stenosis remains challenging. With tracheoplasty using autologous pericardial patch and strips of costal cartilage, long and narrow tracheal stenosis can be repaired. There are no limitations as to the length and location and severity of the stenosis. Tracheoplasty is associated with a high complication rate. A multidisciplinary approach is mandatory to ensure favourable long-term outcomes.
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands a.yazdanbakhsh@amc.uva.nl.
authors.forename: Aria P
authors.initials: AP
authors.lastname: Yazdanbakhsh
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Lennart B
authors.initials: LB
authors.lastname: van Rijssen
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands.
authors.forename: David R
authors.initials: DR
authors.lastname: Koolbergen
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: König
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Bas A J M
authors.initials: BA
authors.lastname: de Mol
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D066186:Costal Cartilage / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000601:surgery; D055815:Young Adult
keywords: Pediatric; Pericardial patch; Surgery; Trachea