%0 Journal Article
%T Open and Thoracoscopic Aortopexy for Airway Malacia in Children: 15 Year Single Centre Experience.
%A Sutton L
%A Maughan E
%A Pianosi K
%A Jama G
%A Rouhani MJ
%A Hewitt R
%A Muthialu N
%A Butler C
%A De Coppi P
%J J Pediatr Surg
%V 59
%N 2
%D 2024 Feb 18
%M 37949688
%F 2.549
%R 10.1016/j.jpedsurg.2023.10.016
%X <B>OBJECTIVE: </B>The objective was to report and analyse the characteristics and results of open aortopexy and thoracoscopic aortopexy for the treatment of airway malacia in a paediatric population.<BR><B>METHODS: </B>We report a retrospective consecutive case series of paediatric patients undergoing aortopexy for the treatment of airway malacia at a quaternary referral centre between December 2006 and January 2021. Outcome measures included days to extubation, continued need for non-invasive ventilation, further intervention in the form of tracheostomy and death.<BR><B>RESULTS: </B>169 patients underwent aortopexy: 147 had open procedures (135 via median/limited median sternotomy and 12 thoracotomy) and 22 thoracoscopic. Mean follow up was 8.46 yrs (range 1-20 yrs). Most common site of airway malacia was the trachea (n = 106, 62.7 %), and 48 (28.4 %) had additional involvement at the bronchi with tracheobronchomalacia (TBM). 15 (8.9 %) had bronchomalacia (BM) only. Incidence of bronchial disease was lower in the thoracoscopic than open group (13.6 % vs 40.82 %; p < 0.0001). Mean time to extubation was 1.45 days, 2.59 days, 5.23 days in tracheomalacia, TBM and BM groups, respectively (p = 0.0047). Mean time to extubation was 1.35 days, 2 days, 3.67 days, and 5 days in patients with external vascular compression, TOF/OA, primary airway malacia, and laryngeal reconstruction, respectively (p = 0.0002). There were 21 deaths across the cohort, and all were in the open group. 71.4 % (n = 15) had bronchial involvement of their airway malacia.<BR><B>CONCLUSIONS: </B>Open and thoracoscopic aortopexy are effective treatments for airway malacia in children. We have identified that involvement of the bronchi is a risk factor for adverse outcomes, and the optimum treatment for this patient cohort is still debatable.<BR><B>METHODS: </B>IV.<BR><B>METHODS: </B>Retrospective Study.