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Pediatric tracheal reconstruction with pericardial patch and strips of autologous cartilage

^a Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
^b Department of Cardiothoracic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
^c Department of Otorhinolaryngology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
^d Department of Anesthesia and Pediatrics Intensive Care, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

Received 3 September 2008; received in revised form 24 February 2009; accepted 25 February 2009.

^_* Corresponding author. Address: Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel.: +31 20 5666005. (Email: m.g.hazekamp{at}lumc.nl).

Objective: To analyze the results of pediatric tracheal reconstruction with autologous pericardial patch and strips of cartilage. Methods: From September 2003 to February 2008 14 non-consecutive children were operated using pericardial patch augmentation of the trachea combined with external reinforcement with strips of autologous cartilage. Thin semicircular strips were fashioned from costal arch cartilage. Associated vascular rings, slings and aberrantly coursing arteries were treated first. Cardiopulmonary bypass was used in all. Intraoperative tracheobronchoscopy was done in all. Postoperative bronchoscopies were performed at different time points. A retrospective analysis of patient records, surgical reports, tracheobronchoscopies, echocardiographic studies and CT scans was performed. Pre- and postoperative trachea cross-sectional areas were digitally measured and compared to cricoid cross-sectional areas in six patients. A paired t-test was used to make comparisons. Results: Median age at operation was 21.3 (range 2.5–85) months. Ten patients were female. Four had associated surgery for cardiac anomalies. Double aortic arch (8), pulmonary artery sling (2), and aberrant origin of brachiocephalic artery (1) were concomitantly treated. Two patients had pulmonary agenesis. One patient had stenosis due to systemic inflammatory disease. Median follow-up was 27 (1–53) months. Late mortality occurred in one patient with pulmonary agenesis. One patient was reoperated and two bronchoscopies were done to remove granulation tissue. Median postoperative ventilation time was 5.5 (3–12) days with the exception of patients with pulmonary agenesis. Mean preoperative cross-sectional area was 29.4 ± 22.5% of the lumen at cricoid level. At last bronchoscopy this had increased to 65.0 ± 12.5% (p = 0.0001). To evaluate the stability of the reconstructed trachea, we compared the mean luminal areas at inspiration and expiration. No difference was observed (p = 0.13). One patient remains with mild stridor at exercise; all others have no respiratory symptoms. Conclusion: A stable wide trachea can be obtained in the great majority of cases, including whole length tracheal obstructions with complete circular rings. The technique is safe and reproducible with short intensive care stay and good mid-term results. Growth of the reconstructed trachea appears to be unrestricted.

Key Words: Trachea • Pediatric • Surgery