Slide tracheoplasty outcomes in children with congenital pulmonary malformations

Michael A. Demarcantonio, Catherine K. Hart, Christina J. Yang, Meredith Tabangin, Michael J. Rutter, Roosevelt Bryant, Peter B. Manning, Alessandro de Alarcón

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives/Hypothesis: Evaluate and compare surgical outcomes of slide tracheoplasty for the treatment of congenital tracheal stenosis in children with and without pulmonary malformations. Study Design: Retrospective chart review at a tertiary care pediatric medical center. Methods: We identified patients with tracheal stenosis who underwent slide tracheoplasty from 2001 to 2014, and a subset of these patients who were diagnosed with congenital pulmonary malformations. Hospital course and preoperative and postoperative complications were recorded. Results: One hundred thirty patients (18 with pulmonary malformations, 112 with normal pulmonary anatomy) were included. Pulmonary malformations included unilateral pulmonary agenesis (61%) and hypoplasia (39%). Children with pulmonary malformations had a greater median age compared to their normal lung anatomy counterparts. Preoperatively, patients with pulmonary malformations more frequently required preoperative mechanical ventilation (55.6% vs. 21.3%, P = .007), extracorporeal membrane oxygenation (ECMO) (11% vs. 0.9%, P = .05), and tracheostomy (22.2% vs. 3.6%, P = .01). Postoperatively, patients with pulmonary malformations more frequently required mechanical ventilation >48 hours (78% vs. 37%, P =.005) and ECMO use (11% vs. 0.9%, P = .05). Pulmonary malformation patients and children with normal anatomy did not differ in terms of postoperative tracheostomy (16.7% vs. 4.4%, P > .05), dehiscence (6% vs. 0%, P > .05%), restenosis (11% vs. 6%, P > .05) or postoperative figure 8 deformity (6% vs. 3%, P > .05). Mortality, however, was significantly increased (22.2% vs. 3.6%, P = .01) in children with pulmonary malformations. Conclusions: Although slide tracheoplasty can be successfully performed in patients with abnormal pulmonary anatomy, surgeons and families should anticipate a more difficult postoperative course, with possible associated prolonged mechanical ventilation, ECMO use, and higher mortality than in children with tracheal stenosis alone.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - 2016

Fingerprint

Lung
Extracorporeal Membrane Oxygenation
Anatomy
Artificial Respiration
Tracheal Stenosis
Tracheostomy
Child Mortality
Tertiary Healthcare
Retrospective Studies
Pediatrics
Mortality

Keywords

  • Complete tracheal rings
  • Pulmonary agenesis
  • Pulmonary hypoplasia
  • Slide tracheoplasty
  • Tracheal stenosis

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Demarcantonio, M. A., Hart, C. K., Yang, C. J., Tabangin, M., Rutter, M. J., Bryant, R., ... de Alarcón, A. (Accepted/In press). Slide tracheoplasty outcomes in children with congenital pulmonary malformations. Laryngoscope. https://doi.org/10.1002/lary.26404

Slide tracheoplasty outcomes in children with congenital pulmonary malformations. / Demarcantonio, Michael A.; Hart, Catherine K.; Yang, Christina J.; Tabangin, Meredith; Rutter, Michael J.; Bryant, Roosevelt; Manning, Peter B.; de Alarcón, Alessandro.

In: Laryngoscope, 2016.

Research output: Contribution to journalArticle

Demarcantonio, MA, Hart, CK, Yang, CJ, Tabangin, M, Rutter, MJ, Bryant, R, Manning, PB & de Alarcón, A 2016, 'Slide tracheoplasty outcomes in children with congenital pulmonary malformations', Laryngoscope. https://doi.org/10.1002/lary.26404
Demarcantonio, Michael A. ; Hart, Catherine K. ; Yang, Christina J. ; Tabangin, Meredith ; Rutter, Michael J. ; Bryant, Roosevelt ; Manning, Peter B. ; de Alarcón, Alessandro. / Slide tracheoplasty outcomes in children with congenital pulmonary malformations. In: Laryngoscope. 2016.
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abstract = "Objectives/Hypothesis: Evaluate and compare surgical outcomes of slide tracheoplasty for the treatment of congenital tracheal stenosis in children with and without pulmonary malformations. Study Design: Retrospective chart review at a tertiary care pediatric medical center. Methods: We identified patients with tracheal stenosis who underwent slide tracheoplasty from 2001 to 2014, and a subset of these patients who were diagnosed with congenital pulmonary malformations. Hospital course and preoperative and postoperative complications were recorded. Results: One hundred thirty patients (18 with pulmonary malformations, 112 with normal pulmonary anatomy) were included. Pulmonary malformations included unilateral pulmonary agenesis (61{\%}) and hypoplasia (39{\%}). Children with pulmonary malformations had a greater median age compared to their normal lung anatomy counterparts. Preoperatively, patients with pulmonary malformations more frequently required preoperative mechanical ventilation (55.6{\%} vs. 21.3{\%}, P = .007), extracorporeal membrane oxygenation (ECMO) (11{\%} vs. 0.9{\%}, P = .05), and tracheostomy (22.2{\%} vs. 3.6{\%}, P = .01). Postoperatively, patients with pulmonary malformations more frequently required mechanical ventilation >48 hours (78{\%} vs. 37{\%}, P =.005) and ECMO use (11{\%} vs. 0.9{\%}, P = .05). Pulmonary malformation patients and children with normal anatomy did not differ in terms of postoperative tracheostomy (16.7{\%} vs. 4.4{\%}, P > .05), dehiscence (6{\%} vs. 0{\%}, P > .05{\%}), restenosis (11{\%} vs. 6{\%}, P > .05) or postoperative figure 8 deformity (6{\%} vs. 3{\%}, P > .05). Mortality, however, was significantly increased (22.2{\%} vs. 3.6{\%}, P = .01) in children with pulmonary malformations. Conclusions: Although slide tracheoplasty can be successfully performed in patients with abnormal pulmonary anatomy, surgeons and families should anticipate a more difficult postoperative course, with possible associated prolonged mechanical ventilation, ECMO use, and higher mortality than in children with tracheal stenosis alone.",
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AB - Objectives/Hypothesis: Evaluate and compare surgical outcomes of slide tracheoplasty for the treatment of congenital tracheal stenosis in children with and without pulmonary malformations. Study Design: Retrospective chart review at a tertiary care pediatric medical center. Methods: We identified patients with tracheal stenosis who underwent slide tracheoplasty from 2001 to 2014, and a subset of these patients who were diagnosed with congenital pulmonary malformations. Hospital course and preoperative and postoperative complications were recorded. Results: One hundred thirty patients (18 with pulmonary malformations, 112 with normal pulmonary anatomy) were included. Pulmonary malformations included unilateral pulmonary agenesis (61%) and hypoplasia (39%). Children with pulmonary malformations had a greater median age compared to their normal lung anatomy counterparts. Preoperatively, patients with pulmonary malformations more frequently required preoperative mechanical ventilation (55.6% vs. 21.3%, P = .007), extracorporeal membrane oxygenation (ECMO) (11% vs. 0.9%, P = .05), and tracheostomy (22.2% vs. 3.6%, P = .01). Postoperatively, patients with pulmonary malformations more frequently required mechanical ventilation >48 hours (78% vs. 37%, P =.005) and ECMO use (11% vs. 0.9%, P = .05). Pulmonary malformation patients and children with normal anatomy did not differ in terms of postoperative tracheostomy (16.7% vs. 4.4%, P > .05), dehiscence (6% vs. 0%, P > .05%), restenosis (11% vs. 6%, P > .05) or postoperative figure 8 deformity (6% vs. 3%, P > .05). Mortality, however, was significantly increased (22.2% vs. 3.6%, P = .01) in children with pulmonary malformations. Conclusions: Although slide tracheoplasty can be successfully performed in patients with abnormal pulmonary anatomy, surgeons and families should anticipate a more difficult postoperative course, with possible associated prolonged mechanical ventilation, ECMO use, and higher mortality than in children with tracheal stenosis alone.

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