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• W2969852493 abstract "Stephens and colleagues1Stephens E.H. Eltayeb O. Mongé M.C. et al.Pediatric tracheal surgery: a 25-year review of slide tracheoplasty and tracheal resection.Ann Thorac Surg. 2020; 109: 148-154Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar have shared a wonderful series of 41 consecutive patients undergoing tracheal resection or slide tracheoplasty, depending on the length of stenosis, from their institution over the past 25 years. They note that with the addition of routine Ciprodex (Alcon Laboratories, Fort Worth, TX), they have moved away from routine postoperative bronchoscopy and have begun to use virtual computed tomography bronchoscopy in recent patients. In this modestly sized cohort, they found that both of these operations are highly effective and safe, with only 3 in-hospital mortalities, although they did not have a high proportion of redo tracheal repairs referred from outside institutions. In addition, multivariate analysis did not identify any predictors of adverse event or in-hospital mortality when factoring in age, concomitant cardiac surgery, and lung agenesis or hypoplasia, among others. As they note, with only 41 patients—9 of whom underwent intracardiac surgery, 8 of whom had lung hypoplasia or agenesis, and 3 of whom died—it is not surprising that multivariate analysis did not identify any predictors of in-hospital mortality or adverse event. Nonetheless, these results are highly supportive of their technique and management strategy, as they are in line with the best reported literature.2Manning P.B. Rutter M.J. Lisec A. Gupta R. Marino B.S. One slide fits all: the versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children.J Thorac Cardiovasc Surg. 2011; 141: 155-161Abstract Full Text Full Text PDF PubMed Scopus (121) Google Scholar, 3Yokoi A. Hasegawa T. Oshima Y. et al.Clinical outcomes after tracheoplasty in patients with congenital tracheal stenosis in 1997-2014.J Pediatr Surg. 2018; 53: 2140-2144Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 4Hofferberth S.C. Watters K. Rahbar R. Fynn-Thompson F. Evolution of surgical approaches in the management of congenital tracheal stenosis: single-center experience.World J Pediatr Congenit Heart Surg. 2016; 7: 16-24Crossref PubMed Scopus (16) Google Scholar, 5Tsugawa C. Nishijima E. Muraji T. et al.Tracheoplasty for long segment congenital tracheal stenosis: analysis of 29 patients over two decades.J Pediatr Surg. 2003; 38: 1703-1706Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar Their 3 mortalities were in highly complex patients, and only 1 mortality was potentially attributable to the patient’s airway disease. It is somewhat surprising that patients undergoing cardiac surgery had outcomes equivalent to those in patients with isolated tracheal lesions. As noted, they experienced longer bypass times and trended toward repairs at a younger age. However, in this series, the intracardiac repairs were relatively straight forward, with most being atrial and ventricular septal defects and modified Blalock-Taussig shunts. An abstract presentation at the 2019 American Association for Thoracic Surgery Annual Meeting demonstrated that patients undergoing tracheal surgery in addition to cardiac surgery had double the risk of in-hospital mortality compared with patients who underwent cardiac surgery alone.6Riggs KW, Tweddell JS, Zafar F, et al. Tracheal surgery triples the risk of hospital mortality in pediatric cardiac surgery patients. Paper presented at: American Association for Thoracic Surgery 99th Annual Meeting. May 5, 2019; Toronto, Canada.Google Scholar Therefore, the combination of surgeries appear to have higher risk, which was believed to be driven by the tracheal surgery. Nonetheless, the authors also agree that it is best to address both defects with one surgery. They found that transferring a patient after intubation to be a risk factor for an adverse event on univariate analysis, which was associated with 5 of 7 adverse events. This finding is not surprising and is likely attributable to the authors working at a large quaternary hospital with a high referral rate, although their number of referrals for re-repair of the trachea (another challenging cohort) was lower than expected. Of the 7 referred patients, 6 also had a pulmonary sling that was repaired. This finding also implies the advantage of referring patients with high-risk diagnoses to more advanced centers early to mitigate the risks of delayed care and the transfer itself. Overall, the authors should be congratulated on this excellent clinical series that advances our knowledge in caring for pediatric patients with tracheal lesions and, when appropriate, promotes us to “keep on sliding.” Pediatric Tracheal Surgery: A 25-Year Review of Slide Tracheoplasty and Tracheal ResectionThe Annals of Thoracic SurgeryVol. 109Issue 1PreviewThe purpose of this study was to assess the outcomes of slide tracheoplasty and tracheal resection in pediatric patients and analyze the data for predictors of outcomes. Full-Text PDF" @default.
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• W2969852493 title "Invited Commentary" @default.
• W2969852493 doi "https://doi.org/10.1016/j.athoracsur.2019.06.099" @default.
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