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Ann Thorac Surg 1999;68:1043-1051
© 1999 The Society of Thoracic Surgeons
a Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital/University of South Florida School of Medicine, St. Petersburg, Florida, USA
b Division of Otolaryngology, All Children’s Hospital, University of South Florida School of Medicine, St. Petersburg, Florida, USA
c Division of Cardiovascular Surgery, Miami Children’s Hospital, Miami, Florida, USA
d Division of Otolaryngology, Miami Children’s Hospital, Miami, Florida, USA
e Division of Cardiovascular Surgery, University of Iowa, Iowa, USA
f Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA
g Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, England, UK
h Division of Otolaryngology, University of Bonn, Bonn, Germany
Address reprint requests to Dr Jacobs, Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital, 603 Seventh St S, Suite 450, St. Petersburg, FL 33701
e-mail: jjacobs1{at}compuserve.com
Presented at the Forty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 12–14, 1998.
Abstract
Background. We reviewed both the North American and the total worldwide pediatric experience with tracheal allograft reconstruction as treatment for patients with long segment and recurrent tracheal stenosis.
Methods. The stenosed tracheal segment is opened to widely patent segments. The anterior cartilage is resected and the posterior trachealis muscle or tracheal wall remains. A temporary silastic intraluminal stent is placed and absorbable sutures secure the chemically preserved cadaveric trachea. After initial success with this technique in Europe, several North American centers have now performed the procedure. The cumulative North American experience includes 6 patients (3 adults and 3 children). Worldwide, more than 100 adults and 31 children, aged 5 months to 18 years, with severe long segment tracheal stenosis have undergone tracheal allograft reconstruction.
Results. In North America, 5 of 6 patients have survived, with one early death due to bleeding from a tracheal-innominate artery fistula in a previously irradiated neck. Worldwide, 26 children survived (26 of 31 = 84%) with follow-up from 5 months to 14 years. Only 1 of 26 pediatric survivors (1 of 26 = 3.8%) had a tracheostomy.
Conclusions. Tracheal allograft reconstruction demonstrates encouraging short- to medium-term results for patients with complex tracheal stenosis. Allograft luminal epithelialization supports the expectation of good long-term results.
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