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Ann Thorac Surg 2003;75:1579-1586
© 2003 The Society of Thoracic Surgeons

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Original article: general thoracic

Tracheobronchial obstruction in children: experience with endoscopic airway stenting

^a department of Thoracic Surgery , Royal Brompton Hospital, London, United Kingdom,
^b department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

Accepted for publication November 22, 2002.

^* Address reprint requests to Dr Goldstraw, Department of Thoracic Surgery, Royal Brompton Hospital, Sydney St, London SW3 6NP, UK.
e-mail: p.goldstraw{at}rbh.nthames.nhs.uk

BACKGROUND: We reviewed our experience to determine the role of endoscopic airway stents in children with tracheobronchial obstruction.

METHODS: Seventeen children (10 boys and 7 girls) aged 2 months to 16 years underwent tracheobronchial stenting. Etiology of the tracheobronchial obstruction included external vascular compression (n = 9); tracheobronchial anastomotic strictures after heart-lung/lung transplantation (n = 4); airway compression by malignant mediastinal mass (n = 2), and subglottic/high tracheal stenosis after prolonged intubation with a tracheostomy in situ (n = 2). Indications for airway stenting were failure to wean from ventilator after a mean of 82.5 days (range, 2 to 210) in 8 children; and dyspnea or stridor in the remaining 9 children.

RESULTS: Ten children had a total of 24 uncovered self-expanding metal stents (either Magic Wallstent or Ultraflex Microvasive) and 7 children had silicone stents (2 straight, 3 Y and 2 T tube stents). At follow-up at 1 week to 72 months (median 21), only 8 of 17 (47%) children were alive but all the deaths were secondary to the underlying pathology and not related to tracheobronchial stenting. Six of 8 ventilator-dependent children were extubated after a mean of 5.3 days (range, 2 to 11) after airway stenting. For the 9 children stented for dyspnea, mean Medical Research Council dyspnea score decreased from 3.0 to 1.6 after stenting.

CONCLUSIONS: Tracheobronchial stenting in children is only rarely needed and often undertaken in dire circumstances. The procedure has led to significant symptomatic benefit in dyspneic children and has enabled ventilator-dependent children to be extubated. Medium-term outlook after stenting with self-expanding metal stents for vascular compression of the airway is encouraging. The long-term outcome remains uncertain, however, and is ultimately influenced by the underlying disease.

This article has been cited by other articles:

				J. L. Anton-Pacheco, D. Cabezali, R. Tejedor, M. Lopez, C. Luna, J. V. Comas, and E. de Miguel The role of airway stenting in pediatric tracheobronchial obstruction Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1069 - 1075. [Abstract] [Full Text] [PDF]