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Eur J Cardiothorac Surg 2000;18:505-512
© 2000 Elsevier Science NL

The role of airway stents in the management of pediatric tracheal, carinal, and bronchial disease

^a Division of Thoracic and Cardiovascular Surgery, All Children's Hospital/University of South Florida School of Medicine, Suite 450, 603 Seventh Street South, St. Petersburg, FL 33701, USA
^b Division of Pediatric Cardiology, All Children's Hospital/University of South Florida School of Medicine, St. Petersburg, FL, USA
^c Cardio-thoracic Unit, Great Ormond Street Hospital for Children, London, UK
^d Division of Otolaryngology, University of Bonn, Bonn, Germany

Received 6 September 1999; received in revised form 7 June 2000; accepted 12 July 2000.

Corresponding author. Tel.: +1-727-8226-666; fax: +1-727-8215-994
e-mail: jjacobs1{at}compuserve.com

Objective: A variety of stents are available to aid in the management of complex tracheal, carinal and bronchial stenoses. We reviewed our multi-institutional experience with airway stents in children. Methods: Thirty-three children (age, 13 days–18 years) from four institutions have had a total of 40 stents placed to aid in the management of complex airway stenoses. Three stent types were utilized: 29 silastic stents, five expandable metal stents and six customized carinal stents (four patients had two stents and one patient had four stents). Thirty children had tracheal stents, six children had bronchial stents, and two infants had carinal stents (three children had stenting of more than one area and two had stenting of all three locations). Twenty-eight patients (age, 5 months–18 years; mean, 8.06 years; SEM, 1.13 years) had stents placed after a variety of airway reconstructive procedures. Four underwent stenting in a non-operative setting and one as preoperative stabilization. Results: Twenty-seven patients survived. One patient died early due to bleeding. Five patients died late: two due to bleeding, one from mediastinitis, and two patients with functional airways died late from unrelated problems. Complications are related to stent type and location. Carinal stents can migrate; several techniques are available to help manage this problem. Wire stents are essentially non-removable requiring periodic dilation. Silastic stents stimulate granulation tissue formation requiring periodic bronchoscopic removal. Conclusion: Tracheal stenting can aid in the management of pediatric airway problems. Complications are common, but can be managed with appropriate intervention.

Key Words: Trachea • Bronchus • Carina • Stent

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