Use of autologous arterial patches for tracheal reconstruction in young infants

Abstract

We read with great interest the article on tracheal replacement with an autologous aortic graft by Martinod and associates [1Martinod E Seguin A Pfeuty K et al.Long-term evaluation of the replacement of the trachea with an autologous aortic graft.Ann Thorac Surg. 2003; 75: 1572-1578Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar]. In long-segment congenital tracheal stenosis in neonates and young infants, the use of a patch is sometimes necessary for tracheal reconstruction. We have performed tracheal patch plasty with autologous pericardium in several patients, but the lack of rigidity of pericardium sometimes resulted in long periods of postoperative ventilatory support.Four years ago, we used an autologous carotid artery patch in a 4-month-old girl with congenital tracheal stenosis. The stenosis started 2 cm under the vocal cords and extended to the bifurcation. The anterior side of the narrowed trachea was augmented with a longitudinally opened segment of the patient's own carotid artery. The semirigid nature of the arterial wall tissue made extubation possible on postoperative day 7. At 4 years of follow-up, the girl remains completely free from symptoms [2Dodge-Khatami A Nijdam N.C Broekhuis E Von Rosenstiel I.A Dahlem P.G Hazekamp M.G Carotid artery patch plasty as a last resort repair for long-segment congenital tracheal stenosis.J Thorac Cardiovasc Surg. 2002; 123: 826-828Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar].Since then, we have used an autologous patch from the ascending aorta to reconstruct long-segment tracheal stenosis in 2 more patients. In both neonates, tracheal narrowing was associated with a tight double aortic arch where division of one arch failed to resolve the tracheal obstruction. One died later of sepsis after an operation for duodenal stenosis, and the second remains asymptomatic 12 months after tracheal repair.If a patch is needed to correct severe long-segment tracheal stenosis, we think that autologous arterial wall tissue is especially suitable for this purpose because of its semirigid nature. As these operations are performed with the use of cardiopulmonary bypass in our experience, harvesting of arterial wall tissue is easy to perform.Although we have no experience with tracheal replacement by a complete segment of the patient's own aorta, we agree with Martinod and colleagues that in select patients, this may be an attractive alternative. However, stent placement would be an issue of concern in small infants. We read with great interest the article on tracheal replacement with an autologous aortic graft by Martinod and associates [1Martinod E Seguin A Pfeuty K et al.Long-term evaluation of the replacement of the trachea with an autologous aortic graft.Ann Thorac Surg. 2003; 75: 1572-1578Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar]. In long-segment congenital tracheal stenosis in neonates and young infants, the use of a patch is sometimes necessary for tracheal reconstruction. We have performed tracheal patch plasty with autologous pericardium in several patients, but the lack of rigidity of pericardium sometimes resulted in long periods of postoperative ventilatory support. Four years ago, we used an autologous carotid artery patch in a 4-month-old girl with congenital tracheal stenosis. The stenosis started 2 cm under the vocal cords and extended to the bifurcation. The anterior side of the narrowed trachea was augmented with a longitudinally opened segment of the patient's own carotid artery. The semirigid nature of the arterial wall tissue made extubation possible on postoperative day 7. At 4 years of follow-up, the girl remains completely free from symptoms [2Dodge-Khatami A Nijdam N.C Broekhuis E Von Rosenstiel I.A Dahlem P.G Hazekamp M.G Carotid artery patch plasty as a last resort repair for long-segment congenital tracheal stenosis.J Thorac Cardiovasc Surg. 2002; 123: 826-828Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar]. Since then, we have used an autologous patch from the ascending aorta to reconstruct long-segment tracheal stenosis in 2 more patients. In both neonates, tracheal narrowing was associated with a tight double aortic arch where division of one arch failed to resolve the tracheal obstruction. One died later of sepsis after an operation for duodenal stenosis, and the second remains asymptomatic 12 months after tracheal repair. If a patch is needed to correct severe long-segment tracheal stenosis, we think that autologous arterial wall tissue is especially suitable for this purpose because of its semirigid nature. As these operations are performed with the use of cardiopulmonary bypass in our experience, harvesting of arterial wall tissue is easy to perform. Although we have no experience with tracheal replacement by a complete segment of the patient's own aorta, we agree with Martinod and colleagues that in select patients, this may be an attractive alternative. However, stent placement would be an issue of concern in small infants. ReplyThe Annals of Thoracic SurgeryVol. 77Issue 6Preview Full-Text PDF