Congenital Tracheal Stenosis With Complete Cartilage Rings: Proposal of A Multidisciplinary and Tailored Surgical Approach.

Abstract

Introduction: Congenital Tracheal Stenosis (CTS) with complete cartilaginous rings is a rare but potentially life-threatening condition in paediatric patients. Currently, the most common approach is slide tracheoplasty (ST) with sternotomy under cardiopulmonary bypass (CPB). Intending to make the procedure less invasive and consider the variety of associated conditions, we have tailored the approach to our patients, who were treated by a multidisciplinary airway team.

Methods: Patients with CTS treated surgically between 2012 and 2022 at Gaslini Institute were enrolled. Preoperative, surgical and postoperative details were collected and analysed retrospectively. All patients had angio-computerized tomography (CT) scan, echocardiography and bronchoscopy with bronchography before surgery. Each patient and each procedure have been discussed at Airway Team meetings.

Results: Among 20 patients with CTS, 15 underwent ST and 5 tracheal resection and anastomosis (TRA). 60 % were younger than 12 months. 30 % patients had previous tracheal/cardiac surgery. Combined cardiac surgery was performed in 8 patients. 4 patients were approached with cervicotomy and extracorporeal membrane oxygenation (ECMO). Mortality within 30 days was 5 %. 8 patients (40 %) needed endoscopic dilatation after the surgery and 1 underwent revision surgery. No patient had tracheostomy after the surgery. We did not find a higher rate of mortality and morbidity in patients who had cervicotomy and ECMO.

Conclusion: We propose a multidisciplinary and tailored approach for patients with CTS. After evaluating each patient through detailed preoperative studies, including bronchography, the team can choose alternatives to the traditional ST under CPB, such as TRA, cervical approach, and ECMO.

Level of evidence: Level IV.

Type of study: Original Article.