Outcomes of reoperation following prior vascular ring and airway compression surgery.

Abstract

After vascular ring repair, the incidence of residual symptoms ranges from 15% to 80%. Symptoms often relate to persistent vascular compression or tracheobronchomalacia. Reoperative surgery, although effective for symptom relief, remains debated due to perceived risks and variable outcomes. This study aims to characterize patients undergoing revisional vascular ring surgery at our institution. We identified patients who underwent reoperations for persistent vascular ring-related symptoms from 1991 to 2024. Patient history, surgical approaches, and clinical outcomes were reviewed. A total of 65 patients underwent reoperative vascular ring surgery, with 44 (68%) initially operated elsewhere. Patients presented with respiratory (94%) and esophageal (66%) symptoms. Operative techniques were tailored to each patient. Esophageal mobilization, lysis of adhesions, or rotational esophagoplasty was performed for persistent esophageal symptoms. Ongoing vascular compression was addressed by interventions such as residual Kommerell's diverticulum resection (n = 32), aberrant subclavian artery reimplantation (n = 19), descending aortic translocation (n = 6), and aortic uncrossing (n = 4). To address tracheobronchomalacia, aortopexy and tracheobronchopexy were performed (n = 57), along with slide tracheoplasty (n = 1) and the use of tracheobronchial splints (n = 1). At a median follow-up of 1.6 years (interquartile range, 6 months to 4.41 years), of the 55% of patients presenting with dysphagia, 75% of patients achieved complete resolution and 83% achieved complete or partial resolution. Respiratory symptom resolution or improvement was observed as follows: Of the 49% presenting with recurrent respiratory infections, 88% showed complete resolution and 94% showed complete or partial resolution; of the 45% reporting stridor or noisy breathing, 100% showed complete resolution; of the 32% presenting with dyspnea upon exertion, 100% showed complete resolution; and of the 46% reporting chronic cough, 83% showed complete resolution and 90% showed complete or partial resolution. Reoperative vascular ring surgery, when guided by understanding the mechanism of symptom etiology and tailored direct surgical approaches, can lead to significant symptom resolution with an acceptable morbidity profile.