outcomes of slide tracheoplastywebcast.aats.org/2013/files/tuesday/20130507_101b_1400_15.45...
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Outcomes of
Slide
Tracheoplasty a 17 year
experience
Simone Speggiorin, Colin Butler, Friso Reinberg, Anja Fierens, Clare
Mclaren ,Derek Roebuck, Samantha Chippington, Nagarajan Muthialu,
Colin Wallis, Hany Gabra, Michele Torre, and Martin J Elliott
the UK National Tracheal Service for Severe Tracheal Disease in Children
at The Great Ormond Street Hospital for Children NHS Foundation Trust
Outcomes of
Slide
Tracheoplasty a 17 year
experience
Simone Speggiorin, Colin Butler, Friso Reinberg, Anja Fierens,
Clare Mclaren ,Derek Roebuck, Samantha Chippington, Nagarajan
Muthialu, Colin Wallis, Hany Gabra, Michele Torre, and Martin J
Elliott
the UK National Tracheal Service for Severe Tracheal Disease in Children
at The Great Ormond Street Hospital for Children NHS Foundation Trust
Long Segment Congenital
Tracheal Stenosis
L S C T S
More that 50% of
its length
Presence of complete
tracheal rings
CTS
CTBS
Normal Arborisation
Pig Bronchus
TrifurcationSingle lung
(52)
(40)
(11) (1)
(10)
(2) (4)
(2)
(1) (1)
(14)
(10) (1)
(1)
(1)
(1)
(2) (2)
(2) (2)
(8)
Speggiorin S, Torre M, Roebuck DJ, McLaren CA, Elliott MJ.
Ann Thorac Surg 2012 93(3):958-61
Anatomical variety
Referral process
Patient
referral Assessment
Stable
Unstable
Ventilate
ECMO
Heliox
…..
Echo
Bronchoscopy
Bronchogram
OCT
CT scan
MRI
always on CPB (relevant technique)
cardiac lesions corrected at same procedure
LPA sling repaired by transfer to MPA
full mobilisation of trachea divide thyroid isthmus
posterior pericardial reflection
rarely hilar release
interrupted, everting, mattress sutures (PDS)
SURGICAL TECHNIQUE
median 5.9 kg
range (1.9-
38.3kg)
median 5.8 m
range (5d-15y)
Age Weight
101 consecutive children M/F =62/39
FROM FEB 1995 TO DEC 2012
71% of patients have
associated cardiac
defects, of which 67%
are a LPA sling
Left pulmonary artery sling 48
Ventricular septal defect 15
Tetralogy of Fallot 10
Atrium septal defect 7
Other* 5
Vascular ring 4
Persistent ductus arteriosus 4
Sub Aortic Stenosis 3
Atrioventricular septal defect 2
Truncus arteriosus + IAA 2
Hypoplastic aortic arch 2
Right aortic arch 2
ASSOCIATED CV ANOMALIES
Minimum tracheal diameter (mm)
Length
all > 50% of trachea
90% > 80% of trachea
mean = 2.2mm
sd = 0.64
the
tra
ch
ea
l te
am
at
GO
S
POSTOPERATIVELY
VENTILATION 11 Days (0-
477)
ICU LOS 20 Days (2-755)
MALACIA 20 (20%)
Site Complication Incidence
Wound Mediastinitis 9 (8.9%)
Airway Residual stenosis at 9 months 8 (7.9%)
Dehiscence/redo 3 (3.0%)
Unplanned extubation 2 (2.0%)
Chest/Pulmonary Pneumothorax 6 (5.9%)
Chylothorax 4 (4.0%)
Pneumo -mediastinum/pericardium 4 (4.0%)
PHT 2 (2.0%)
Cardiac Tamponade 1 (1.0%)
Nerve Phrenic nerve 4 (4.0%)
RLN palsy 3 (3.0%)
COMPLICATIONS
POSTOPERATIVELY
ENDOSCOPIC 48 (48%)
PROCEDURES
3 OR > 33 (33%)
STENTING 22 (22%)
BALLOON DILATATION 45 (45%)*
*Over first
4 months
STENTS
Stents/patients 37/22
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1995-2005 2006-2012
Stented pts
non stented pts
27.5% 19.4%
STENTS
0
5
10
15
20
25
30
1995-2008 2009-2012
balloon expandable steel
Nitinol self expandable
PDS reabsorbable
STP for any anatomical variant
What we have learnt
Malacia can improve over time
OCT and bronchogram are helpful
Key indicators for outcome malacia
and bronchial stenosis
Reabsorbable stents may help
Comments
•MDT and team work
•Centralization of the service
•Obsessional fup
•Improving materials (ie reab sutures and
stents)