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Midterm outcomes of pulmonary artery sling repair with and without tracheoplasty

Published online by Cambridge University Press:  13 October 2020

Ziyad M. Binsalamah*
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Alyssa Thomason
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Christopher Ibarra
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Zachary Spigel
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Iki Adachi
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Katherine E. Barton
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Evan Edmunds
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Christopher A. Caldarone
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Michiaki Imamura
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Jeffrey S. Heinle
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: Ziyad M. Binsalamah, MD, MSc, FRCSC, Division of Congenital Heart Surgery, Texas Children’s Hospital, 6651 Main street, LT19345H, Houston, TX77030, USA. Tel: +1 832 826 1929; Fax: +1 832 825 1905. E-mail: [email protected]

Abstract

Objective:

Review a single-centre experience with pulmonary artery sling repair and evaluate risk factors for re-intervention.

Methods:

Patients with surgically repaired pulmonary artery sling at a single institution between 1996 and 2018 were retrospectively reviewed. A univariate Cox regression analysis was used to evaluate variables for association with freedom from re-intervention.

Results:

Eighteen patients had pulmonary artery sling repair. At operation, median age and weight were 6.9 months (interquartile range 4.1–18.1) and 9.5 kg (interquartile range 6.5–14.5), respectively. A median hospital length of stay was 12 days (interquartile range 5.8–55.3). Twelve patients (67%) had complete tracheal rings, of whom six (50%) underwent tracheoplasty (five concurrently with pulmonary artery sling repair). Airway re-intervention was required in five (83%) of the six patients who underwent tracheoplasty. One patient had intraoperative diagnosis and repair of pulmonary artery sling during unrelated lesion repair and required tracheoplasty 24 days post-operatively. One patient died 55 days after pulmonary artery sling repair and tracheoplasty following multiple arrests and re-interventions. Median post-operative follow-up for surviving patients was 6.3 years (interquartile range 11 months–13 years), at which time freedom from re-intervention was 61%. When controlling for patient and tracheal size, initial tracheoplasty was associated with decreased freedom from re-intervention (hazard ratio 21.9, 95% confidence interval 1.7–284.3, p = 0.018).

Conclusions:

In patients with pulmonary artery sling, tracheoplasty is associated with decreased freedom from re-intervention. In select patients with pulmonary artery sling and complete tracheal rings, conservative management without tracheoplasty is feasible. Further study is necessary to delineate objective indications for tracheoplasty.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

IRB approval: H-42751 (3/7/2018–3/5/19).

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