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Abstract
Background Tracheobronchomalacia can be quite resistant for treatment in children. They can be either isolated or as part of more extensive pathology, especially in those children with trachea-esophageal fistula. Anterior aortopexy, posterior tracheopexy or combination of both can provide symptomatic relief to patients having severe tracheomalacia. In this study we aim to analysis the clinical outcomes after aortopexy and tracheopexy in severe tracheomalacia
Methods All patients who underwent either anterior aortopexy or posterior tracheopexy or both from June 2018 to August 2021 were retrospectively reviewed.
Data collection included severity of symptoms, need for pre-operative non-invasive or invasive ventilation, pathology causing tracheomalacia, surgical treatment offered (all under flexible bronchoscopy guidance) and approach used (mini sternotomy, complete sternotomy, thoracotomy or thoracoscopy), post-op ventilation time and complications
Results 53 patients operated. Median age was 5 months (3, 12.5) and median weight was 6.1kgs (4, 9.5). Among 51 (96%) presented with respiratory distress, 33 (62%) had apneic spells and 34 (64%) had stridor. 33 (62%) required additional airway support like BIPAP and CPAP, 30 patients (56%) were on ventilation and 3 patients (5%) had tracheostomy before surgery. Tracheomalacia involved mostly the distal (47%) trachea. Median sternotomy was the most common approach ( 70%). 27 patients underwent combined posterior tracheopexy and anterior aortopexy and 24 patients underwent isolated anterior aortopexy. Mean ventilation duration was 48 hrs. only 5% required tracheostomy. Morality was 2% (n =1). Median follow-up was 6 months (4, 28). 88% ( n = 46) remained well at 6 months with no additional support and minimal to nil respiratory symptoms.
Conclusion In severe tracheomalacia, aortopexy addresses anterior vascular compression, but does not address posterior membranous tracheal intrusion. Posterior tracheopexy directly address the posterior membranous tracheal intrusion and demonstrate significant improvement or resolution of symptoms and airway collapse improving the success of aortopexy.
