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Anterior Pericardial Tracheoplasty for Congenital Tracheal Stenosis: Long Term Outcomes
N. H. Fanous1, S. A. Husain2, M. W. Turrentine1, M. D. Rodefeld1, J. W. Brown1. 1Indiana University School of Medicine, Indianapolis, IN, 2University of Florida School of Medicine, Gainesville, FL,
Background: Several techniques have been described for the treatment of tracheal stenosis including slide tracheoplasty, rib grafting and the use of a pericardial patch. The optimal repair remains controversial secondary to the lack of long term follow-up data. The purpose of this study is to examine the long term results of anterior pericardial tracheoplasty.
Methods: To assess the long term outcomes of patients who underwent repair of tracheal stenosis with anterior pericardial tracheoplasty, we reviewed case histories of 27 consecutive patients (1984-present). All but 5 patients had long segment tracheal stenosis with more than 10 complete tracheal rings. Twenty one patients had significant associated cardiac disease and 10 had their cardiac lesions repaired concurrently. The median age was 6 months (2d-25yrs). All patients underwent anterior pericardial tracheoplasty through a median sternotomy on normothermic cardiopulmonary bypass. We have previously described our tracheoplasty technique. An average of 14 tracheal rings (5-22) were divided anteriorly and a patch of fresh autologous pericardium was used to enlarge the trachea to 1.5 times the predicted diameter for age and weight.
Results: There was one hospital death and 2 late deaths (at 7mo, 1yr and 2yr postoperatively). Two patients required tracheostomy postoperatively, one secondary to formation of granulation tissue and the other secondary to failure to wean from mechanical ventilation. All survivors remain asymptomatic, with minimal to no evidence of airway obstruction. Median follow-up is 11 years (3mo-22yrs).
Conclusions: Anterior pericardial tracheoplasty for congenital tracheal stenosis provides excellent results in the majority of patients at long-term follow-up.
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