Slide Tracheoplasty in Infants and Children: Risk Factors for Prolonged Postoperative Ventilatory Support

• Published in: The Annals of thoracic surgery Vol. 85; no. 4; pp. 1187 - 1192
• Main Authors: Manning, Peter B., MD, Rutter, Michael J., MD, Border, William L., MBChB
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2008
• Subjects: Abnormalities, Multiple - diagnosis; Abnormalities, Multiple - mortality; Abnormalities, Multiple - surgery; Adolescent; Analysis of Variance; Anastomosis, Surgical; Bronchoscopy - methods; Cardiopulmonary Bypass - methods; Cardiothoracic Surgery; Child; Child, Preschool; Cohort Studies; Female; Follow-Up Studies; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Length of Stay; Logistic Models; Male; Multivariate Analysis; Odds Ratio; Postoperative Care - methods; Probability; Reconstructive Surgical Procedures - methods; Respiration, Artificial - methods; Retrospective Studies; Risk Assessment; Severity of Illness Index; Surgery; Survival Analysis; Trachea - surgery; Tracheal Stenosis - congenital; Tracheal Stenosis - diagnosis; Tracheal Stenosis - mortality; Tracheal Stenosis - surgery; Ventilator Weaning - trends; 15
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2007.11.019

Background A single-institution experience with slide tracheoplasty for management of tracheal stenosis in children with emphasis on identifying predictors of prolonged postoperative mechanical ventilation is reviewed. Methods Patient characteristics, hospital course, and outcomes for children undergoing slide tracheoplasty were recorded. Univariate and multivariate analysis was performed to identify factors leading to prolonged mechanical ventilation (>48 hours postoperatively). Results Since April 2001, 40 children underwent slide tracheoplasty utilizing cardiopulmonary bypass (CPB) support at a median age of 6.2 months (range, 7 days to 15 years), and median weight of 6.1 kg (range, 1.9 to 57 kg). Thirteen patients had undergone prior operations. Thirteen patients (32.5%) were mechanically ventilated before operation. Thirteen patients underwent additional procedures at the time of the slide tracheoplasty. Mean CBP support time was 123 minutes. Seven patients required aortic cross-clamping (mean, 69 minutes). There were 2 early and 2 late deaths, none related to the tracheoplasty. One patient required repair of a recurrent tracheal stenosis, 4 patients required tracheotomy, and 3 required temporary stent placement. Twenty-one patients (52.5%) were extubated within 48 hours after tracheoplasty. Univariate and multivariate analysis revealed only preoperative mechanical ventilatory support (odds ratio 28.4, p = 0.015) and duration of CPB support (odds ratio 1.06, p = 0.007) to be significant predictors of the need for prolonged intubation. Conclusions Slide tracheoplasty utilizing CPB support is a versatile and effective treatment for tracheal stenosis in children even when combined with repair of congenital cardiac anomalies. Most children can be successfully weaned from mechanical ventilatory support early after repair.