| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2007;31:331. doi:10.1016/j.ejcts.2006.10.028
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Letters to the Editor |
a Department of Cardiac Surgery, University of Heidelberg, INF 110, D-69120 Heidelberg, Germany
b Department of Pediatric Cardiology, University of Heidelberg, INF 110, D-69120 Heidelberg, Germany
Received 23 October 2006; accepted 25 October 2006.
* Corresponding author. Tel.: +49 6221 56 6272; fax: +49 6221 56 5919. (Email: Tsvetomir.Loukanov{at}med.uni-heidelberg.de).
Key Words: Congenital tracheal stenosis • Cardiopulmonary bypass
We read with great interest the article of Anton-Pacheco et al. [1] in which they analyzed 19 cases with congenital tracheal stenosis. This single center study consisted of different groups of patients, classified to the severity and length of the tracheal stenosis. The authors described three different surgical techniques with an overall mortality rate of 21%. The rate of mortality in Anton-Pacheco's series exceeds clearly all contemporary standards published in the literature in the last decade [2] (early mortality 6% and late mortality 12%). The authors reported excellent results with slide tracheoplasty in 7 patients but very poor clinical outcome with costal cartilage tracheoplasty. Cardiopulmonary bypass (CPB) was used in all patients with slide tracheoplasty but only occasionally in cases using the cartilage tracheoplasty and in cases presenting with short segment stenosis.
According to our experience based on 37 patients with tracheal pathology, isolated or associated with congenital heart malformations the use of CPB in the surgical management of these patients is very useful and represents an effective tool. In our hands the survival rate was 97% despite of the associated cardiovascular malformations, higher percentage of redo procedures and the complexity of surgical interventions. We attempted surgical treatment of tracheal pathology with simultaneous repair of congenital cardiac lesions in most of the cases [3]. The crucial part of our surgical technique regarding the tracheal part of the operation was careful dissection and mobilization of the trachea, main bronchi, pulmonary arteries and veins in order to obtain tension-free tracheal anastomosis.
In our experience the key element in the surgical approach for such patients represents the use of CBP which allowed extensive mobilization of the whole tracheobronchial tree and resection of the trachea with end-to-end tension free anastomotic reconstruction. The use of CPB avoids any additional tension when placing or tying the sutures at the tracheal anastomotic site. The use of CPB allows mobilization of longer (above 30%) segments of the trachea which are then feasible for resection and reconstruction with end-to-end anastomosis.
We emphasize also on the intraoperative use of endoscopic monitoring of the airways. It permits careful exploration for identifying residual tracheal stenosis and facilitates clearing of secretions at the end of operation.
We are strongly convinced that the use of CPB and monitoring of the surgical procedure by intraoperative bronchoscopy are the cornerstones in the successful management of patients with congenital tracheal stenosis.
Footnotes
\#9734; The authors of the original paper [1] were invited to comment on this Letter to the Editor but declined the offer.
References
This article has been cited by other articles:
|
|
 |
|
  M. G. Keane and R. E. Pyeritz Medical Management of Marfan Syndrome Circulation, May 27, 2008; 117(21): 2802 - 2813. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
