41 Aortopexy for tracheomalacia via a suprasternal incision
Zeni Haveliwala, Iain Yardley
Evelina Childrens Hospital, London, United Kingdom

Abstract

Aim
Tracheomalacia is caused by flaccidity of the tracheal wall leading to tracheal collapse, particularly on expiration. Often it requires no treatment but when severe can warrant surgical intervention. Aortopexy is one surgical option and has been described using a variety of approaches.

We aim to report outcomes of aortopexy performed via a suprasternal incision in a single centre, by a single surgeon. 

 

Methods
All patients undergoing aortopexy between February 2016 and January 2018 were prospectively included.  Patients were managed by a multi-disciplinary team (MDT) comprising ENT, paediatric and cardiac surgeons, paediatric intensivists, cardiologists and respiratory physicians. All underwent standardised work-up including dynamic flexible bronchoscopy (DFB) and contrast enhanced CT. Aortopexy was performed via a suprasternal skin crease incision.  Surgery was guided by intra-operative flexible bronchoscopy.

Data regarding pre-operative symptoms, degree of tracheomalacia and outcomes were recorded.

 

Main results
Eighteen patients were included, 14 boys, median age 5 months (range 1 month – 5 years). Underlying diagnoses and outcomes are as in the table.  Two aortopexy sutures were used in all cases, three patients required an additional tracheopexy suture. Median operating time was 1 hour 24 minutes (range 47 minutes – 2 hour 35 minutes). Median pre-operative tracheal collapse on DFB was 85% (range 80-95%), improving to 35% (35-80%) intra-operatively. Median post-operative length of stay was 5 days (range 1-118).  


Conclusions
Aortopexy via a suprasternal incision is a useful treatment modality for tracheomalacia with short operating times and rapid recovery.

Outcomes vary with the best results in the TOF and premature groups.  Careful patient selection and MDT work-up are essential to optimise outcomes.


 Pre-operative diagnosis (n)

Outcome (n)

 Symptom free

 Improved

 No change

 TOF (7)

3

3

1

 Premature birth (4)

3

1

0

 Syndromic (3)

0

0

3

 Others (4)

1

2

1




Website
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