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J Thorac Cardiovasc Surg 1998;115:869-874
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Repair of congenital tracheal stenosis with a free tracheal autograft

From the Divisions of Cardiovascular-Thoracic Surgery and Otolaryngology, Children's Memorial Hospital, and the Departments of Surgery and Otolaryngology-Head and Neck Surgery, Northwestern University Medical School, Chicago, Ill.

Received for publication June 13, 1997. Revisions requested August 11, 1997; revisions received Sept. 11, 1997. Accepted for publication Sept. 11, 1997. Address for reprints: Carl L. Backer, MD, Division of Cardiovascular-Thoracic Surgery-M/C #22, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614.

Objectives: Evaluate the results of a technique for repair of congenital tracheal stenosis by use of a free tracheal autograft.
Methods: Between January 1996 and July 1997, six infants with congenital tracheal stenosis resulting from complete tracheal rings underwent repair with a free tracheal autograft. Mean age at the time of repair was 4.9 months; mean weight was 5.4 kg. The approach was through a median sternotomy with cardiopulmonary bypass for respiratory support. The trachea was incised anteriorly through the area of stenosis, the midportion of the stenotic trachea was excised, and an end-to-end anastomosis was carried out posteriorly. The excised tracheal segment (1.3 to 2.2 cm long) was used as a free autograft to patch the lower trachea anteriorly. In four infants the autograft was augmented in the upper trachea with pericardium; in two patients with a shorter length of stenosis, the autograft completed the repair. Simultaneous pulmonary artery sling repair (4), ligation and division of patent ductus arteriosus (3), cricoid split (2), atrial and ventricular septal defect repair (1), and complete atrioventricular canal repair (1) were performed at the time of tracheal repair.
Results: The infants were extubated and discharged at a mean of 13 and 23 days postoperatively, respectively. One infant had recurrent tracheal stenosis related to the pericardial patch and required a tracheal stent and tracheostomy 4 months postoperatively. Our mean follow-up is 11 months. Bronchoscopic findings currently show widely patent tracheal lumina in all infants.
Conclusions: The technique of free tracheal autograft with and without pericardial augmentation was successful in opening the airway of six infants with congenital tracheal stenosis and is currently our procedure of choice for children with this diagnosis. (J Thorac Cardiovasc Surg 1998;115:869-74)

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