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Long-term Outcomes Of Children Undergoing The Slide Tracheoplasty: An Institutional Review Of 226 Patients
Spencer J. Hogue, BS1, Amir Mehdizadeh-Shrifi, MD
1, Aadhyasri Ramineni, BA
1, Sara Zak, MD
2, Dan T. Benscoter, DO, MS
2, Meghan M. Chlebowski, MD, MHPE
3, David S. Cooper, MD, MPH, MBA
3, Alessandro de Alarcon, MD, MPH
4, David L. S. Morales, MD
1, Michael J. Rutter, MD, MBChB, FRACS
4, David G. Lehenbauer, MD
1.
1Division of Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,
2Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,
3Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA,
4Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Objectives: Literature on the slide tracheoplasty-(ST) remains limited to small institutional experiences. Therefore, the authors analyzed the largest single institutional experience of ST.
Methods: All consecutive patients who underwent ST at the authors’ institution 2001-2023 were retrospectively reviewed.
Results: 226 patients, including 120-(53%) infants and 147-(65%) with congenital heart disease-(CHD), were identified. Twenty-nine-(13%) patients had a single lung. Preoperatively, 51-(23%) patients underwent ≥1 cardiac surgery and 34-(15%) had prior tracheoplasties at outside hospitals requiring revision. Forty-eight-(21%) patients were intubated pre-ST. Intraoperatively, 215-(95%) patients had full cardiopulmonary bypass perfusion-[11 STs were performed on extracorporeal membrane oxygenation-(ECMO)], and 94-(42%) patients underwent concomitant cardiac repair. Postoperatively, 94-(42%) patients were extubated early-(≤24 hours). In-hospital complications included tracheal dehiscence-(10%,n=23) and airway infection-(23%,n=53). Reinterventions included reintubation-(20%,n=45), endotracheal stent placement-(8%,n=17), tracheostomy dependence-(5%,n=12), and novel ECMO-(4%,n=10). The 5- and 10-year freedoms from tracheoplasty revision were 91% and 87%, respectively.
Significant risk factors for postoperative mortality included single lung anatomy-(HR=2.93, CI=1.04-8.24, p=0.042), postoperative endotracheal stent placement-(HR=3.03, CI=1.03-8.95, p=0.044), preoperative intubation-(HR=3.08, CI=1.22-7.78, p=0.017), CHD-(HR=5.93, CI=1.33-26.38, p=0.019), postoperative tracheostomy dependence-(HR=16.74, CI=4.46-62.85, p<0.001), and novel postoperative ECMO-(HR=23.91, CI=7.07-80.84, p<0.001). Overall, the in-hospital, 5-, and 10-year survivals were 93%, 88%, and 86%, respectively. (Figure)
Conclusions: Tracheal anomalies present a complex physiologic state with limited reports on outcomes. The present series, the largest institutional report to date, demonstrates that excellent long-term outcomes following slide tracheoplasty are achievable.
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