Slide Tracheoplasty in Long Segment Tracheobronchial Stenosis

Abstract

Background: Long segmental congenital tracheal stenosis and long segmental congenital tracheobronchial stenosis are rare congenital airway anomalies with variable arborizations. This study aimed to analyze presentations and outcomes of slide tracheoplasty in long segmental congenital tracheal and tracheobronchial stenosis with variable arborizations.

Methods: Retrospective analysis included all patients who underwent slide tracheoplasty between March 1995 and February 2023 for long segmental congenital tracheal and tracheobronchial stenosis at the Great Ormond Street Hospital for Children (London, United Kingdom). Preoperative airway morphology was divided into anatomic types on the basis of the Great Ormond Street Hospital for Children morphologic classification. Preoperative, intraoperative, postoperative, and follow-up variables were analyzed and compared among patients with different arborizations with long segmental congenital tracheal and tracheobronchial stenosis.

Results: A total of 210 patients underwent slide tracheoplasty for long segmental congenital tracheal and tracheobronchial stenosis. The median age at surgery was 6 months (interquartile range, 3-15 months), and the median weight was 6.4 kg (interquartile range, 4.2-8.7 kg). Of these patients, 40% (n = 85) had abnormal arborization, and tracheobronchial morphology was the most common. A total of 24% (n = 50) patients had stenosis extending to 1 or more bronchi. Patients with carinal trifurcation presented early with critical airway stenosis, requiring ventilation support (60%) and extracorporeal membrane oxygenation support (35%) as bridge therapy to slide tracheoplasty. The duration of postoperative ventilation was higher in the patients with congenital tracheobronchial stenosis (P = .006). Patients with a morphology with trifurcation arborization had higher mortality (23%) and stent requirement (35%).

Conclusions: Slide tracheoplasty remains the standard surgery for long segmental congenital tracheal and tracheobronchial stenosis even with different arborizations. Preoperative identification of tracheal arborizations and of the extent of stenosis aids surgical strategies for better outcomes.