DOZ047.106: Internal stents and external splints for complex airway obstruction

Abstract

Abstract Background Life-threatening airway obstruction due to severe tracheobronchial stenosis or tracheobronchomalacia not amenable to tracheobronchopexy or resection is still a challenge, and warrants aggressive innovative strategies. In this study, our experience with placement of balloon-expandable stents and/or external bioabsorbable splints in children with severe tracheobronchial obstruction was reviewed. Methods All patients with symptomatic severe airway obstruction who underwent interaluminal stent and/or external splint placement (1997–2019) were retrospectively reviewed. The data collected included age, type of obstruction (stenosis or malacia), associated malformations, technical and clinical success, complications, and outcomes. Airway stents were placed under fluoroscopic guidance. Bioabsorbable splints (RapidSorb, Synthes CMF) were custom molded and then secured externally on the collapsing areas under simultaneous bronchoscopic and direct visualization. Results Seventeen patients underwent 14 airway stents (trachea = 5, bronchi = 9) and/or 11 external bioabsorbable splints (trachea = 5, bronchi = 6) at a median age of 5 months (IQR 3–9 months). Fourteen stents were placed in 8 patients, 10 external splints in 8 patients; one patient had two stents and one splint. Indications for stenting were stenotic airways in 11 patients (postoperative = 7, congenital = 4) and severe distal airway malacia in 3. All the external bioabsorbable splints were placed in patients with severe airway malacia secondary to lack of cartilaginous support and/or extrinsic compression. During follow-up 3/9 stented patients and 3/9 splinted patients did not experience any significant adverse events. Six of nine stented patients experienced serious adverse events: significant in-stent stenosis (n = 3), stent migration, and obstructive granulation tissue (n = 1), erosion through airway wall (n = 1), and death (n = 2). Of the nine splinted patients, one bronchial splint fractured, requiring replacement, and five patients required tracheostomies for continued respiratory failure from unilateral pulmonary hypoplasia and residual distal tracheal stenosis (n = 1), severe tracheomalacia (n = 2), subglottic stenosis (n = 1), and laryngeal cleft (n = 1). One patient died a week after surgery. Conclusion Airway internal stenting and external bioabsorbable splinting are effective therapeutic strategies for selected patients with complex airway abnormalities. Bioabsorbable splints are effective in maintaining airway patency, and being absorbable allow for age-proportional growth of the airways. Airway stents can be associated with significant adverse events and therefore should be reserved for patients who have failed other therapeutical strategies.