Materials for tracheoplasty: Which work? which are best?

Abstract

We read with interest the report by Niwa and associates1Niwa H Masaoka A Yamakawa Y Hara F Kondo K Fukai I et al.Esophageal tracheobronchoplasty for diseases of the central airway.J Thorac Cardiovasc Surg. 1996; 112: 124-129Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar of their clinical experience in infants and adults undergoing esophageal tracheobronchoplasty for a variety of congenital and acquired tracheal lesions. In their discussion these authors expressed the view that on occasion homologous pericardium may not be strong enough to serve as patch material for tracheoplasty procedures. At the risk of overestimating the values of anecdotal observations, we can report that lyophilized homograft pulmonary artery patches have been used in two infants undergoing anterior tracheoplasties. These patients, aged 5 and 3 months, required simultaneous correction of congenital heart lesions (interrupted aortic arch type B with ventricular septal defect and pulmonary artery sling, respectively). These procedures were done according to methods and management protocols previously described by others.2Edmunds Jr, LH Norwood WI Low LW Atlas of cardiothoracic surgery.in: Lea & Febiger, Philadelphia1990: 154-155Google Scholar, 3Idriss FS Delson SU Ilbawi MM Gerson CR Tacker GF Holinger L Tracheoplasty with pericardial patch for extensive tracheal stenosis in infants and children.J Thorac Cardiovasc Surg. 1984; 88: 526-527Google Scholar, 4Hamansohn DA Kesler KA Turentine MW Mahomed Y Means L Maff B et al.Anterior pericardial tracheoplasty for congenital tracheal stenosis.J Thorac Cardiovasc Surg. 1991; 102: 710-716PubMed Google Scholar In addition, fibrin sealant was used for suture-line sealing. In both of these patients, progress has been satisfactory over intervals of 3 ¾ and 2 ¾ years, respectively. Bronchoscopies were done at 1 ½ year and 2 years in the first patient and at 1 years in the second. These studies showed slight tracheal irregularity, no stenosis, and apparent epithelialization (biopsies not done) (patches were placed adventitia outward). Faint calcifications in the region of these patches appeared by 6 to 12 months on chest x-ray films. As the authors noted in their discussion, several patch materials can “work” on tracheoplasty procedures. In infants similar to those described here, perhaps lyophilized pulmonary artery homograft can be added to the list. However, it remains to be determined which material is best and in what circumstances. For this reason, we appreciated this report of esophageal tracheobronchoplasty and note the need for further investigations in this area.