Surgical management strategy of slide tracheoplasty for infants with congenital tracheal stenosis

ABSTRACT [Objective] To evaluate the outcomes of slide tracheoplasty in infancy and identify predictors of adverse outcomes. [Methods] We retrospectively reviewed the clinical data of infants less than one year old with congenital tracheal stenosis (CTS) who underwent slide tracheoplasty at a single center from April 2010 to September 2020. [Results] Of 120 infants, 71.7% (86/120) had a pulmonary artery sling, and 37.5% (45/120) had simultaneous intracardiac repairs. Additionally, 52.5% (63/120) of the patients had anomalous tracheobronchial arborization, and 17.5% (21/120) had diffuse tracheal stenosis. Six airway reoperations (5%) and 6 deaths (5%) occurred, and the mortality decreased annually. Multivariate analysis revealed that a low body weight, cardiovascular anomalies and normal tracheobronchial arborization predicted a longer intubation duration. Univariate analysis revealed that a low body weight, preoperative invasive ventilation, a long cardiopulmonary bypass time and granulation tissue were associated with death. After surgery, twenty-six patients had dysphagia, 24 of whom resumed oral feeding during follow-up. Ninety-two patients underwent chest CT reexamination, and the trachea diameter had increased significantly from 2.32 ±0.72 mm to 5.46 ±1.24 mm. Nineteen and 29 patients underwent spirometry before and after surgery, respectively, and showed improvements in ventilation function, with the TPTEF%TE and VPEF%VE values significantly improved from 19.80 (IQR:16.90-23.80) % and 23.10 (IQR:21.10-25.90) % to 26.80 (IQR:21.20-34.40) % and 30.20 (IQR:25.00-34.50) %, respectively (P [Conclusion] A tailored individual management strategy of slide tracheoplasty in infancy facilitates favorable clinical outcomes. Close postoperative follow-up and long-term functional evaluations including clinical symptoms and pulmonary function are still needed.