Wong, ZH;
Hewitt, R;
Cross, K;
Butler, C;
Yeh, Y-T;
Ramaswamy, M;
Blackburn, S;
... De Coppi, P; + view all
(2020)
Thoracoscopic aortopexy for symptomatic tracheobronchomalacia.
Journal Of Pediatric Surgery
, 55
(2)
pp. 229-233.
10.1016/j.jpedsurg.2019.10.034.
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Abstract
Aim: Symptomatic tracheobronchomalacia can be fatal. Successful treatment includes aortopexy. We report outcomes of the thoracoscopic approach in a single centre. Methods: All patients undergoing thoracoscopic aortopexies from 2009 to 2018 were retrospectively reviewed. Data was reported as median (interquartile range). Risk factors for subsequent tracheostomy were analyzed with logistics regression model, p < 0.05 as significant. Results: Twenty-one patients with mid to distal tracheomalacia (n = 17) and bronchial involvement (n = 4) were determined on bronchoscopy, tracheobronchogram, or CT thorax. Preoperative patient demographics and comorbidities, e.g., gastro-oesophageal reflux disease, prematurity, and cardiac anomalies were recorded. Indications for thoracoscopic aortopexy were apparent life-threatening event(s) (n = 14), recurrent chest infections (n = 5), and failure to wean invasive ventilation (n = 2). Thoracoscopic aortopexies (n = 20) with conversion to open (n = 1) were performed. Intraoperative bleeding (n = 2) occurred, and chest tube (n = 1) was inserted for monitoring. Intraoperative bronchoscopy (n = 17) confirmed improvement of tracheomalacia. Anesthetic time was 140 (90–160) minutes. Postoperatively, 2 patients had dehiscence of the aorta from the sternum. They underwent redo open aortopexy with posterior tracheopexy, and 1 required subsequent tracheostomy. Another 2 patients required tracheostomies. Potential risk factors for subsequent tracheostomy were investigated, and only the association of tracheobronchomalacia was close to significance (OR 16 (95% CI 0.95–267.03), p = 0.05). Follow up duration was 365 (72–854) days. Symptoms resolution occurred in n = 17 (81%) of patients. Conclusion: Different modalities were used to delineate the site of tracheobronchomalacia and its etiology. Tracheomalacia with bronchial involvement may be a risk factor for subsequent tracheostomy.
| Type: | Article |
|---|---|
| Title: | Thoracoscopic aortopexy for symptomatic tracheobronchomalacia |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jpedsurg.2019.10.034 |
| Publisher version: | https://doi.org/10.1016/j.jpedsurg.2019.10.034 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | tracheobronchomalacia, esophageal atresia, thoracoscopic, aortopexy, tracheostomy, bronchoscopy, tracheobronchogram |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10108569 |
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