Great vessel anomalies and their impact on the surgical treatment of tracheobronchomalacia.
BACKGROUND: Tracheobronchial compression (TBC) from great vessel anomalies (GVA) can contribute to tracheobronchomalacia (TBM) symptoms. The frequency, impact on symptoms and optimal management of GVA in these patients, with or without a history of esophageal atresia (EA), are still unclear.
STUDY DESIGN: Patients who underwent surgery for TBM/ TBC between 2001 and 2017 were reviewed. Demographics, type of GVA, and operative interventions were collected. The frequency and treatment modalities of GVA between EA and non-EA patients were compared.
RESULTS: Overall, 209 patients met criteria; 120 (57.4%) patients had at least one GVA, including double aortic arches (n = 4, 1.9%), right aortic arches (n = 14, 6.7%), aberrant right subclavian arteries (n = 15, 7.2%), and innominate artery compression (n = 71, 34.0%). Non-EA patients were more likely to have surgery later in life (29.5 months versus 16 months, p = 0.0002), double aortic arch (p = 0.0174), right aortic arch (p < 0.0001), and undergo vascular reconstruction concurrently with their airway procedure (25% vs 8.4%, p = 0.002). Vessel reconstruction was performed in 25 patients; six required cardiac bypass.
CONCLUSION: The frequency of GVA in patients with symptomatic airway collapse is substantial. Multidisciplinary evaluation is imperative for operative planning as many require complex reconstruction and collaboration with cardiac surgery, particularly patients without a history of EA.
LEVEL OF EVIDENCE: Level III.
Journal of pediatric surgery
Aortic arch anomalies; Esophageal atresia; Great vessel anomalies; Tracheobronchial compression (TBC); Tracheobronchomalacia (TBM); Tracheopexy
Svetanoff, W., Zendejas, B., Smithers, C. J., Prabhu, S. P., Baird, C. W., Jennings, R. W., Hamilton, T. E. Great vessel anomalies and their impact on the surgical treatment of tracheobronchomalacia. Journal of pediatric surgery 55, 1302-1308 (2020).