Outcomes of

Slide

Tracheoplasty a 17 year

experience

Simone Speggiorin, Colin Butler, Friso Reinberg, Anja Fierens, Clare

Mclaren ,Derek Roebuck, Samantha Chippington, Nagarajan Muthialu,

Colin Wallis, Hany Gabra, Michele Torre, and Martin J Elliott

the UK National Tracheal Service for Severe Tracheal Disease in Children

at The Great Ormond Street Hospital for Children NHS Foundation Trust

Outcomes of

Slide

Tracheoplasty a 17 year

experience

Simone Speggiorin, Colin Butler, Friso Reinberg, Anja Fierens,

Clare Mclaren ,Derek Roebuck, Samantha Chippington, Nagarajan

Muthialu, Colin Wallis, Hany Gabra, Michele Torre, and Martin J

Elliott

the UK National Tracheal Service for Severe Tracheal Disease in Children

at The Great Ormond Street Hospital for Children NHS Foundation Trust

no commercial interests

Long Segment Congenital

Tracheal Stenosis

L S C T S

More that 50% of

its length

Presence of complete

tracheal rings

CTS

CTBS

Normal Arborisation

Pig Bronchus

TrifurcationSingle lung

(52)

(40)

(11) (1)

(10)

(2) (4)

(2)

(1) (1)

(14)

(10) (1)

(1)

(1)

(1)

(2) (2)

(2) (2)

(8)

Speggiorin S, Torre M, Roebuck DJ, McLaren CA, Elliott MJ.

Ann Thorac Surg 2012 93(3):958-61

Anatomical variety

Referral process

Patient

referral Assessment

Stable

Unstable

Ventilate

ECMO

Heliox

…..

Echo

Bronchoscopy

Bronchogram

OCT

CT scan

MRI

VALUE OF OCT

optical coherence

tomography

Normal

Complete ring

No ring

always on CPB (relevant technique)

cardiac lesions corrected at same procedure

LPA sling repaired by transfer to MPA

full mobilisation of trachea divide thyroid isthmus

posterior pericardial reflection

rarely hilar release

interrupted, everting, mattress sutures (PDS)

SURGICAL TECHNIQUE

median 5.9 kg

range (1.9-

38.3kg)

median 5.8 m

range (5d-15y)

Age Weight

101 consecutive children M/F =62/39

FROM FEB 1995 TO DEC 2012

71% of patients have

associated cardiac

defects, of which 67%

are a LPA sling

Left pulmonary artery sling 48

Ventricular septal defect 15

Tetralogy of Fallot 10

Atrium septal defect 7

Other* 5

Vascular ring 4

Persistent ductus arteriosus 4

Sub Aortic Stenosis 3

Atrioventricular septal defect 2

Truncus arteriosus + IAA 2

Hypoplastic aortic arch 2

Right aortic arch 2

ASSOCIATED CV ANOMALIES

-ECMO 10 (10%)

-VENTILATION 56 (55%)

PREOPERATIVELY

-CONGENITAL 43(43%)

ANOMALIES

-BRONCHIAL STENOSIS 24 (23.7%)

-DISTAL MALACIA 24(24%)

PREOPERATIVELY

Minimum tracheal diameter (mm)

Length

all > 50% of trachea

90% > 80% of trachea

mean = 2.2mm

sd = 0.64

the

tra

ch

ea

l te

am

at

GO

S

POSTOPERATIVELY

VENTILATION 11 Days (0-

477)

ICU LOS 20 Days (2-755)

MALACIA 20 (20%)

Site Complication Incidence

Wound Mediastinitis 9 (8.9%)

Airway Residual stenosis at 9 months 8 (7.9%)

Dehiscence/redo 3 (3.0%)

Unplanned extubation 2 (2.0%)

Chest/Pulmonary Pneumothorax 6 (5.9%)

Chylothorax 4 (4.0%)

Pneumo -mediastinum/pericardium 4 (4.0%)

PHT 2 (2.0%)

Cardiac Tamponade 1 (1.0%)

Nerve Phrenic nerve 4 (4.0%)

RLN palsy 3 (3.0%)

COMPLICATIONS

POSTOPERATIVELY

ENDOSCOPIC 48 (48%)

PROCEDURES

3 OR > 33 (33%)

STENTING 22 (22%)

BALLOON DILATATION 45 (45%)*

*Over first

4 months

STENTS

Stents/patients 37/22

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1995-2005 2006-2012

Stented pts

non stented pts

27.5% 19.4%

STENTS

0

5

10

15

20

25

30

1995-2008 2009-2012

balloon expandable steel

Nitinol self expandable

PDS reabsorbable

100% follow-up 4.6yrs (2.7 m-17 y)

Overall Probability of Survival

after Slide Tracheoplasty

88.3%

<30 day Late

Airway-related 4pts 2

cardiac 2 2

other 2

MORTALITY

Multivariable Regression Analysis

HR = hazard ratio

94.6%

64.6%

p<0.001

PREOP DISTAL MALACIA VS MORTALITY

82.6%

30.0%

p<0.001

PREOP DISTAL MALACIA VS STENTING

STP for any anatomical variant

What we have learnt

Malacia can improve over time

OCT and bronchogram are helpful

Key indicators for outcome malacia

and bronchial stenosis

Reabsorbable stents may help

Comments

•MDT and team work

•Centralization of the service

•Obsessional fup

•Improving materials (ie reab sutures and

stents)

Thank to

POSTOP VENTILATION

MORTALITY BY ERA

BRONCHOGRAM

OCT

Tsang V, Murday A, Gillbe C, Goldstraw P

Slide tracheoplasty for congenital funnel-shaped

tracheal stenosis

Ann Thorac Surg 1989 Nov;48(5):632-5

Slide Tracheoplasty