Abstract 12872: External Stenting for Tracheobronchomalacia Associated With Congenital Heart Disease

Abstract

Introduction: Tracheobronchomalacia (TBM) is a disease of symptomatic obstruction of tracheal or bronchial portions either related to congenital instability or secondary to vascular compression. Patients with TBM associated with congenital heart disease (CHD) often remain difficult to manage after cardiac surgery, requiring prolonged artificial respiratory support. Under these circumstances, several treatments such as aortopexy, internal stenting, or high positive end-expiratory pressure ventilation, have been attempted, although satisfactory results have not been obtained. In 2008, we started the external stenting technique using a ringed expanded polytetrafluoroethylene graft, and we have treated 39 patients with this technique. We review the results of our experience with external stenting for TBM in children. Methods: Clinical records of 42 procedures in 39 patients with TBM, who underwent external stenting in our institute from February 2008 to March 2014, were reviewed. The diagnosis of TBM was made by bronchoscopy or enhanced computed tomography. Results: Etiology of the tracheobronchial obstruction included primary TBM in 10 cases (25.6%), congenital vascular compression in 14 (35.9%), and postoperative vascular compression in 15 (38.5%). Preoperatively, 30 patients (76.9%) were failure to wean from ventilation, 9 (23.1%) were performed tracheotomy, and 5 (12.8%) were performed aortopexy. Forty-six stents were placed in 39 children, 22 boys and 17 girls, with a median age of 7 months (range, 1 months - 6 years). Sixteen stents were placed in the trachea, 25 were placed in the left main bronchus, and 5 were placed in the right main bronchus. Stenosis-free tracheobronchial expansion was achieved in 38 (97.4%) patients. Thirty five (89.7%) patients were successfully weaned from respirator, and 36 (92.3%) discharged from a hospital. Complications of the operation occurred in 4 (9.5%) of the 42 procedures. One patient died of a perioperative bleeding. Three patients were necessitated their stent removals due to bronchial perforation, bronchial stenosis, and pulmonary venous obstruction. Conclusions: External stenting seems to be extremely useful in the treatment of intractable TBM associated with CHD.