| Popis: |
Introduction The indications and optimal age for aortopexy remain a subject of debate. Aortopexy is performed in children with moderate to severe airways symptoms (recurrent stridor, need for intubation and ventilation) and tracheomalacia, caused by pulsatile tracheal compression from innominate artery. We report our results with early age aortopexy in patients with and without tracheo oesophageal fistula (TOF). Method Between 2011- 2016, 52 children underwent aortopexy in our centre. Median age at surgery was 9 months. This procedure was performed using a standard open surgical approach, with partial thymectomy and 2–3 sutures placed to lift innominate artery. Twelve patients had tracheopexy at the same time as the aortopexy. Mean follow-up period after surgery was 36 months. We retrospectively collected data on preoperative symptoms, pre and postop bronchoscopy and clinical outcomes. Results The clinical presentation was heterogenous. Patients with associated TOF (23%) had overall more severe symptoms, that occurred in 75% of these cases. The patients without TOF presented with severe symptoms only in 50% of cases. The degree of tracheal/bronchial compression, as assessed by bronchoscopy was: mild (0%–50%) in 6% of the cases, moderate (50%–70%) in 27% and severe (>70%) in 67% of cases. The severity of clinical presentation was significantly corelated with the degree of stenosis (p=0.003). Three cases had failure of aortopexy sutures 3 months post procedure and required repeat procedure. All of these patients had TOF. At last available follow-up: 59.6% patient had a significant improvement, 26.9% had improvement with persisting respiratory symptoms, 9.5% were static and 3.8% died from unrelated causes. Fifteen percent of patients presented at least one life threatening event at any point after surgery. An improvement of the degree of tracheal compression by more than 25% was found in 80% of the patients. Twenty-nine patients (55.7%) had sleep studies. 28.8% of the last sleep studies performed were normal, 13.4% showed mild OSA, 9.6% showed mixed disorder (OSA and Hypoventilation) and 3.8% had central events. Conclusion Aortopexy, as a curative treatment for tracheomalacia produced by tracheal compression, is effective and has low morbidity and mortality from a young age. |
