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Open and Thoracoscopic Aortopexy for Airway Malacia in Children: 15 Year Single Centre Experience

Sutton, Liam; Maughan, Elizabeth; Pianosi, Kiersten; Jama, Guled; Rouhani, Maral J; Hewitt, Richard; Muthialu, Nagarajan; ... De Coppi, Paolo; + view all (2024) Open and Thoracoscopic Aortopexy for Airway Malacia in Children: 15 Year Single Centre Experience. Journal of Pediatric Surgery , 59 (2) pp. 197-201. 10.1016/j.jpedsurg.2023.10.016. Green open access

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Abstract

Objectives: The objective was to report and analyse the characteristics and results of open aortopexy and thoroscopic aortopexy for the treatment of airway malacia in a paediatric population. / Methods: We report a retrospective consecutive case series of paediatric patients undergoing aortopexy for the treatment of airway malacia at a quaternary referral centre between December 2006 and January 2021. Outcome measures included days to extubation, continued need for non-invasive ventilation, further intervention in the form of tracheostomy and death. / Results: 169 patients underwent aortopexy: 147 had open procedures (135 via median/limited median sternotomy and 12 thoracotomy) and 22 thoracoscopic. Mean follow up was 8.46 yrs (range 1-20 yrs). Most common site of airway malacia was the trachea (n=106, 62.7%), and 48(28.4%) had additional involvement at the bronchi with tracheobronchomalacia(TBM). 15(8.9%) had bronchomalacia(BM) only. Incidence of bronchial disease was lower in the thoracoscopic than open group (13.6% vs 40.82%; p<0.0001). Mean time to extubation was 1.45 days, 2.59 days, 5.23 days in tracheomalacia, TBM and BM groups, respectively (p=0.0047). Mean time to extubation was 1.35 days, 2 days, 3.67 days, and 5 days in patients with external vascular compression, TOF/OA, primary airway malacia, and laryngeal reconstruction, respectively (p=0.0002). There were 21 deaths across the cohort, and all were in the open group. 71.4% (n=15) had bronchial involvement of their airway malacia. / Conclusions: Open and thoroscopic aortopexy are effective treatments for airway malacia in children. We have identified that involvement of the bronchi is a risk factor for adverse outcomes, and the optimum treatment for this patient cohort is still debatable. / Level of Evidence: IV / Type of Study: Retrospective Study

Type: Article
Title: Open and Thoracoscopic Aortopexy for Airway Malacia in Children: 15 Year Single Centre Experience
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jpedsurg.2023.10.016
Publisher version: https://doi.org/10.1016/j.jpedsurg.2023.10.016
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Aortopexy, Tracheomalacia, Tracheopexy, Tracheobronchomalacia, Bronchomalacia
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept
URI: https://discovery-pp.ucl.ac.uk/id/eprint/10179888
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