Outcomes of slide tracheoplasty in 101 children: a 17-year single-center experience.
OBJECTIVE
Our study describes the results from surgical slide tracheoplasty (STP) in children with long segment tracheal stenosis.


METHODS
Demographic and preoperative conditions, operative details, and outcome measures, including the need for endoscopic airway intervention and mortality, were collected for children undergoing STP between February 1995 and December 2012.


RESULTS
One hundred one patients (median age, 5.8 months; range, 5 days-15 years) underwent STP. Seventy-two patients (71.3%) had associated cardiovascular anomalies. Preoperative ventilation was necessary in 56 patients (55.4%), whereas extracorporeal membrane oxygenation was required in 10 patients (9.9%). Abnormal bronchial arborization was present in 39 children (38.6%), which included 13 patients (12.8%) with an anomalous right upper lobe bronchus and 17 patients (16.8%) with tracheal trifurcation. Airway stenosis extended into 1 or both bronchi in 24 patients (23.7%) and preoperative malacia was present in 24 patients (23.7%). STP was extended into the bronchus in 47 patients (46.5%). Overall survival was 88.2% (mortality in 12 patients). Post-STP balloon dilation was necessary in 45 patients (44.6%) and stenting was required in 22 patients (21.8%). Multivariate analysis revealed preoperative extracorporeal membrane oxygenation (P < .05), preoperative malacia (P < .001), and bronchial stenosis (P < .05) to be adverse predictors of survival. Preoperative malacia was a significant risk factor for stenting (P < .05).


CONCLUSIONS
STP is a versatile and reliable technique associated with low morbidity and mortality when compared with previous strategies for children with long segment tracheal stenosis. The presence of preoperative bronchomalacia is a significant risk factor for death and postoperative stenting.
The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom. Electronic address: colin.butler@gosh.nhs.uk.
Colin R
CR
Butler
The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom.
Simone
S
Speggiorin
The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom.
Friso M
FM
Rijnberg
The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom.
Derek J
DJ
Roebuck
The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom.
Nagarajan
N
Muthialu
The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom.
Richard J
RJ
Hewitt
The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom.
Martin J
MJ
Elliott
D000293:Adolescent; D000367:Age Factors; D055091:Bronchomalacia / Q000150:complications; D002648:Child; D002675:Child, Preschool; D004106:Dilatation; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D014135:Tracheal Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome