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J Thorac Cardiovasc Surg 2001;121:0068-0076
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery

Partial cricoidectomy with primary thyrotracheal anastomosis for postintubation subglottic stenosis

Paolo Macchiarini, MD, PhDa, Jean-Philippe Verhoye, MDb, Alain Chapelier, MD, PhDb, Elie Fadel, MDb, Philippe Dartevelle, MDb

From the Departments of Thoracic and Vascular Surgery,a Heidehaus Hospital, Hannover Medical School, Hannover, Germany, and Thoracic and Vascular Surgery and Heart-Lung Transplantation,b Hôpital Marie-Lannelongue, Le Plessis Robinson, Paris-Sud University, France.

Received for publication May 4, 2000. Revisions requested Aug 9, 2000; revisions received Aug 25, 2000. Accepted for publication Sept 8, 2000. Address for reprints: Paolo Macchiarini, MD, PhD, Department of Thoracic and Vascular Surgery, Heidehaus Hospital, Hannover Medical School, Am Leineufer, 70, 30419 Hannover, Germany (E-mail: pmacchiarini{at}compuserve.com).

Objective: We describe a Pearson-type technique and evaluate its results for postintubation subglottic stenosis.
Methods: Forty-five patients underwent a partial cricoidectomy with primary thyrotracheal anastomosis, and 5 underwent simultaneous repair of a tracheoesophageal fistula as well. Twenty-four (53%) patients were referred to us after initial conservative (n = 21) or operative (n = 3) management. There were 27 cuff lesions, 7 stomal lesions, and 11 at both levels. The upper limit of the stenosis was 1.5 cm (range, 1-2.5 cm) below the cords, and the subglottic diameter was reduced by 60% in 38 (84%) of the patients. The length of airway resection ranged from 2 to 6 cm (median, 3 cm). Despite 23 thyrohyoid or suprahyoid releases, 8 anastomoses were under tension.
Results: Thirty-seven (82%) patients were extubated after the operation (n = 30) or within 24 hours (n = 7). Six patients required postoperative airway stenting (median, 5.5 days). Early (<30 days) complications occurred in 18 (41%) patients, mainly as transient airway and voice complaints, aspiration, and dysphagia. One (2%) patient died of myocardial infarction. Late morbidities were 2 failures occurring as bilateral recurrent nerve paralysis and restenosis requiring definitive tracheostomy. Patients had excellent or good anatomic (n = 42 [96%]), functional (n = 41 [93%]), or both types of long-lasting results, with no stenotic relapse.
Conclusions: Partial cricoidectomy with primary thyrotracheal anastomosis can be applied in patients with postintubation stenosis extending up to 1 cm below the cords and measuring up to 6 cm in length with excellent-to-good definitive results. The association with a tracheoesophageal fistula does not contraindicate surgical repair.






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