ТОРАКОСКОПИЧЕСКАЯ АОРТОПЕКСИЯ В ЛЕЧЕНИИ ДЫХАТЕЛЬНЫХ РАССТРОЙСТВ, ОБУСЛОВЛЕННЫХ ТРАХЕОМАЛЯЦИЕЙ

Abstract

The most common treatment for tracheomalacia (TM) in children is aortopexy. This surgical procedure can be performed using a thoracoscopy. The study represents the 18 surgical cases’ experience of thoracoscopic fixation of the aorta to the posterior wall of the sternum and the analysis of the pre- and postoperative parameters of patients that would allow judging the benefits of the procedure in the treatment of obstructive tracheal diseases in infants. Materials and methods: a single-center experimental uncontrolled study was carried out. The thoracoscopic aortopexy was performed by the same operating surgeon but in different hospitals in 18 patients with TM. The median age of patients was 50.5 [36.8; 60.0] days. Among them were 10 (56%) boys and 8 (44%) girls. The TM was caused by the esophageal atresia in 17 patients, and by the vascular compression in another patient. The diagnosis of the anomaly was confirmed by the tracheobronchoscopy. The degree of tracheal narrowing was calculated using the formula proposed by Dr. Russell W. Jennings, MD, co-director of the Esophageal and Airway Treatment Center with the Boston Children's Hospital (Boston, Massachusetts, USA). All of the surgical interventions were performed thoracoscopically with the use of the three thoracoports. Three sutures were placed on the anterior wall of the ascending aorta, the threads of which were passed through the body of the sternum and tied subcutaneously. The patients’ parameters (their age and intraoperative parameters, as well as the data of tracheobronchoscopy performed before and after surgery) were studied in the final part of the study as well. Results: all of the aortopexies were performed using a fully thoracoscopic technique. The median span of the surgical intervention was 75.0 [60.0; 90.0] minutes (in the range of 50.0 to 100.0 minutes). The median duration of respiratory support after surgery was 1.0 [1.0; 2.3] days (in the range of 1.0 to 4.0 days). The duration of drainage of the anterior mediastinum did not exceed 1 day. The length of hospital stay did not exceed 14 days (in the range of 7.0 to 14.0 days) with 9.0 [7.0; 11.3] days as the median. The complete disappearance of disease symptoms was noted in 77.8 [52.4; 93.6] % of cases. The health improvement consisting of the mitigation of symptoms of obstructive lesions of the upper respiratory tract was observed in 16.7 [3.6; 41.4] % of patients. In one case (5.5 [0.1; 27.3] %) the severity of respiratory symptoms remained unchanged: in three months after the aortopexy this patient has underwent the lower tracheostomy. The objective assessment of the trachea and bronchi patency was performed with the Dr. Russell W. Jennings’ scale. The median score of the trachea and bronchi collapse before the surgery was 260.0 [240.0; 272.5]. The postoperative tracheobronchoscopy was performed in different periods after surgical interventions: from 10 days up to 3 months after the surgery: the median score of the trachea and bronchi collapse after the surgery was 445.0 [430.0; 460.0] (p<0.001). Conclusion: based on the objective criterion that evaluates the opening of the lumen of the upper respiratory tract it can be argued that thoracoscopic aortopexy is an effective procedure for the treatment of TM in children.