Long-Term Outcomes of Children Undergoing the Slide Tracheoplasty: An Institutional Review of 227 Patients.

Abstract

Literature on the slide tracheoplasty-(STP) is primarily limited to small institutional experiences. Therefore, the authors analyzed their large institutional experience of STP. All consecutive patients who underwent thoracic STP on cardiopulmonary bypass-(CPB) or extracorporeal membrane oxygenation-(ECMO) at the authors' institution 2001-2023 were retrospectively reviewed. Two-hundred twenty-seven patients, including 120-(53%) infants and 122-(54%) with congenital heart disease-(CHD), were identified. Thirty-two-(14%) patients had a single functional lung-(SFL). Preoperatively, 44-(19%) patients underwent ≥1 cardiac surgery and 34-(15%) had prior tracheoplasties at outside hospitals requiring revision. Forty-eight-(21%) patients were intubated pre-STP. Intraoperatively, 212-(93%) patients underwent CPB perfusion-(15 STPs were performed on ECMO), and 78-(34%) patients underwent concomitant cardiac repair. Postoperatively, 94-(42%) patients were extubated early-(≤24 hours). In-hospital complications included tracheal dehiscence-(5%, n=12) and airway infection-(23%, n=53). Reinterventions included reintubation-(19%, n=44), endotracheal stent-(ETS) placement-(8%, n=18), tracheostomy dependence-(5%, n=11), and novel ECMO cannulation-(4%, n=10). The 5- and 10-year freedoms from tracheoplasty revision were 95% and 91%, respectively. Upon multivariable regression, factors significantly-(p<0.05) associated with postoperative mortality included: SFL-(HR=5.14, CI=1.73-15.29, p=0.003), CHD-(HR=4.34, CI=1.45-12.93, p=0.009), postoperative ETS placement-(HR=3.79, CI=1.21-11.87, p=0.022), postoperative tracheostomy dependence-(HR=9.54, CI=2.86-31.81, p<0.001), postoperative tracheal dehiscence-(HR=6.48, CI=1.17-35.81, p=0.032), ECMO pre- through post-STP-(HR=6.39, CI=1.44-28.31, p=0.015), and novel postoperative ECMO-(HR=20.70, CI=5.22-82.09, p<0.001). Overall, the in-hospital, 5-, and 10-year survivals were 93%, 88%, and 86%, respectively. Tracheal anomalies present a complex physiologic state with limited reports on outcomes and associated perioperative factors. The present series, the largest institutional experience in the United States to date, demonstrates that excellent long-term outcomes following slide tracheoplasty are achievable.