P-06: Novel Technique for The Correction of Severe Tracheobronchomalacia

Abstract

Tracheobronchomalacia (TBM) may result in severe, apparent life-threatening events and debilitating respiratory compromise requiring surgery in children. Our aim was to describe a series of patients who underwent isolated posterior tracheopexies to treat severe TBM. All patients treated at our hospital for TBM from January 2011 to June 2014 were retrospectively reviewed. A previously described classification system was utilized to describe the specific location of malacia. Estimated gestational age, gender, comorbid conditions, endoscopic evaluations, surgical technique, and complications were collected. A novel endoscopic score evaluated severity between preoperative and postoperative exam. Nineteen underwent posterior tracheopexies (Figure 1). Primary indication was respiratory distress. Thirty-two percent were female. Fifty-three percent were premature. Median gestational age was 37 weeks (range: 31–40 weeks). Seventy-four percent had one-comorbid condition; either cardiac or VACTERL. Eleven-percent had a previously performed operation. Median number of bronchoscopies was 3 bronchoscopies (range 1–10). Median age at operation was 10 months (range: 2–168 months). Median weight was 6.4 kg (range: 3.8–38.8 kg). Operative approach was determined by the surgeon and not randomized; 11% by median sternotomy, 84% by thoracotomy, and 5% utilizing both. No short-term recurrences or complications have occurred. Median decrease in TBM endoscopic severity score was 7 (range: 1–16) in 10 patients. In this series of patients, an evolution in the manner in which TBM was surgically treated occurred. Given the heterogeneity of this patient population, larger studies are needed to ascertain longer-term outcomes and the validity of the TBM endoscopic score.