Aortopexy offers surgical options for a variety of pathological tracheal conditions in paediatric patients
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Aortopexy offers surgical options for a variety of pathological tracheal conditions in paediatric patients. / Gruszka, Anna; Sachweh, Joerg S; Schnoering, Heike; Tenbrock, Klaus; Muehler, Eberhard G; Laschat, Michael; Vazquez-Jimenez, Jaime F.
in: INTERACT CARDIOV TH, Jahrgang 25, Nr. 4, 01.10.2017, S. 589-594.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Aortopexy offers surgical options for a variety of pathological tracheal conditions in paediatric patients
AU - Gruszka, Anna
AU - Sachweh, Joerg S
AU - Schnoering, Heike
AU - Tenbrock, Klaus
AU - Muehler, Eberhard G
AU - Laschat, Michael
AU - Vazquez-Jimenez, Jaime F
N1 - © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - OBJECTIVES: Aortopexy is widely used; however, many surgeons still regard it with suspicion. To date, there are only a few large series and minimal long-term data. Against this background, our goal was to report our experience, particularly with regard to the recent expansion of indications and modification of diagnostic routine and surgical strategy.METHODS: Between 1994 and 2012, 53 patients (mean age: 1.1 years; 5 weeks-10.2 years) were operated on. Tracheomalacia after the operation for oesophageal atresia was the main indication for aortopexy (74%), followed by tracheal compression by the innominate artery (17%) and other selected indications (9%). Computed tomography angiography has emerged in recent years as the method of choice for preoperative diagnosis. Median sternotomy has replaced lateral thoracotomy, and intraoperative bronchoscopy has become the standard.RESULTS: In contrast to magnetic resonance imaging, computed tomography angiography resulted in perfect visualization of the condition. Median sternotomy and simultaneous bronchoscopy led to immediate readjustment of the aortopexy sutures in 6 patients. There were no surgical deaths or serious morbidities. The mean follow-up was 4.9 (0.3-14.9) years. Two patients with additional complex diseases died during the follow-up period. In all survivors, symptoms improved markedly or disappeared. However, we observed an increased susceptibility to lower respiratory tract infections over the long-term (32%).CONCLUSIONS: Aortopexy is effective for treating tracheomalacia of different origins and other pathological conditions as well. Preoperative computed tomography angiography offers excellent visualization of the condition. Median sternotomy and intraoperative bronchoscopy provide a combination for reliable operative and long-term results. However, many patients still have an increased susceptibility to lower respiratory tract infections.
AB - OBJECTIVES: Aortopexy is widely used; however, many surgeons still regard it with suspicion. To date, there are only a few large series and minimal long-term data. Against this background, our goal was to report our experience, particularly with regard to the recent expansion of indications and modification of diagnostic routine and surgical strategy.METHODS: Between 1994 and 2012, 53 patients (mean age: 1.1 years; 5 weeks-10.2 years) were operated on. Tracheomalacia after the operation for oesophageal atresia was the main indication for aortopexy (74%), followed by tracheal compression by the innominate artery (17%) and other selected indications (9%). Computed tomography angiography has emerged in recent years as the method of choice for preoperative diagnosis. Median sternotomy has replaced lateral thoracotomy, and intraoperative bronchoscopy has become the standard.RESULTS: In contrast to magnetic resonance imaging, computed tomography angiography resulted in perfect visualization of the condition. Median sternotomy and simultaneous bronchoscopy led to immediate readjustment of the aortopexy sutures in 6 patients. There were no surgical deaths or serious morbidities. The mean follow-up was 4.9 (0.3-14.9) years. Two patients with additional complex diseases died during the follow-up period. In all survivors, symptoms improved markedly or disappeared. However, we observed an increased susceptibility to lower respiratory tract infections over the long-term (32%).CONCLUSIONS: Aortopexy is effective for treating tracheomalacia of different origins and other pathological conditions as well. Preoperative computed tomography angiography offers excellent visualization of the condition. Median sternotomy and intraoperative bronchoscopy provide a combination for reliable operative and long-term results. However, many patients still have an increased susceptibility to lower respiratory tract infections.
KW - Airway Obstruction/diagnosis
KW - Aorta, Thoracic/surgery
KW - Bronchoscopy/methods
KW - Child
KW - Child, Preschool
KW - Computed Tomography Angiography
KW - Esophageal Atresia/complications
KW - Female
KW - Follow-Up Studies
KW - Forecasting
KW - Humans
KW - Infant
KW - Magnetic Resonance Imaging
KW - Male
KW - Retrospective Studies
KW - Suture Techniques
KW - Trachea/diagnostic imaging
KW - Tracheomalacia/complications
KW - Vascular Surgical Procedures/methods
U2 - 10.1093/icvts/ivx163
DO - 10.1093/icvts/ivx163
M3 - SCORING: Journal article
C2 - 28605441
VL - 25
SP - 589
EP - 594
JO - INTERACT CARDIOV TH
JF - INTERACT CARDIOV TH
SN - 1569-9293
IS - 4
ER -