RTST Has Good Outcomes for Pediatric Tracheal Stenosis

by Amy E. Hamaker •

How successful is revision thoracic slide tracheoplasty (RTST) following unsuccessful prior tracheal reconstruction in the management of congenital tracheal stenosis?

Bottom line
Despite some differences in postoperative management when compared to non-revision cases, RTST can be successfully performed after prior tracheal reconstruction with good postoperative outcomes.

Background: Pediatric tracheal stenosis, most commonly caused by complete tracheal rings, is potentially lethal in the absence of repair due to the instability of the airway and the high incidence of cardiopulmonary comorbidities. Early surgical intervention is the mainstay for most children. Despite some successes, results are often unsatisfactory, and the potential for restenosis is high. Prognosis has improved dramatically using RTST and treatment outcomes have become more predictable.

Study design: Retrospective analysis of 26 patients undergoing TST on cardiopulmonary bypass between January 2005 and May 2014.

Setting: Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A.

Synopsis: Twenty-three patients had a history of complete tracheal rings, and three patients had cartilaginous deficiency. There were no appreciable differences in patient characteristics between those undergoing primary and revision TST apart from being older and more likely to have undergone prior cardiac surgery at the time of RTST. A total of 14 tracheostomies and 41 prior airway procedures were performed prior to revision. The most common procedures performed pre-RTST included pericardial patch, rib grafting, and slide tracheoplasty. RTST was performed electively within one week of arrival for most patients. Patients undergoing RTST were less likely to undergo a simultaneous cardiac procedure but equally likely to require bronchoplasty or other airway procedures intraoperatively. The vocal fold immobility Rate was 15.4% among patients undergoing revision surgery and 4% among the non-revision TST control population. The median duration of postoperative ventilation was shorter in RTST patients and they had a median follow-up time of 10.8 months and five tracheobronchoscopies compared to 2.2 months and four tracheobronchoscopies in the TST population.

Citation: Sidell DR, Hart CK, Tabangin ME, et al. Revision thoracic slide tracheology: outcomes following unsuccessful tracheal reconstruction. Laryngoscope. May 4, 2018. doi:10.1002/lary.27145