Slide Tracheoplasty: Intermediate outcomes in Developing Country

K. Trung. Nguyen¹, V. Quang. Tran², V. Thi. Nguyen³, Y. Thi. Nguyen¹, C. Thanh. Le⁴, T. Van. Dang⁵, T. Jun⁶, T. Ly Thinh. Nguyen^7
1Department of Pediatric, Hanoi Medical University, Hanoi, Ha Noi ²Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Ha Noi ³Department of Cardiology, Heart Center, Vietnam National Children's Hospital, Hanoi, Ha Noi ⁴Department of Pneumology, Vietnam National Children's Hospital, Hanoi, Ha Noi ⁵Department of Cardiac ICU, Heart Center, Vietnam National Children's Hospital, Hanoi, Ha Noi ⁶Department of Thoracic and Cardiovascular Surgery, Samsung Medical CenterSungkyunkwan University School of Medicine, Seoul, Seoul-t'ukpyolsi ⁷Department of Cardiovascular Surgery , Heart Center, Vietnam National Children's Hospital, Ha Noi, Ha Noi

Purpose: Children with congenital trachea stenosis born in the developing world face a high risk of mortality due to limited access to proper treatment. This study aims to describe the intermediate outcomes and risk factors of slide tracheoplasty (STP) in a single center in Vietnam.

Methods: From 2016 to 2022, 103 children who underwent STP to treat congenital complete trachea rings were retrospectively reviewed. The median age and weight were 7 months (IQR, 3.5-13.4 months) and 6.7 kg (IQR, 5.3-9.0 kg). There were 88 patients (85.4%) had excessive long-segment trachea stenosis (>50% of trachea length). A comparative study was performed to analyze the difference between patients with respiratory distress who required emergency operation (unstable-group A=43) and patients who had stable conditions who were on schedule (stable-group B=60). Patients in the unstable group had significantly younger (p=0.002), and lower body weight (p=0.009). Positive with bacteria and viral culture preoperatively is higher in the unstable group (p=0.003). Predictor factors for death, requiring longer ventilation, and reintervention for the airway were tested with multivariate Cox regression analysis. Competing risk analysis was performed to analyze the cumulative incidence of death and reoperation.

Results: Perioperative results revealed that group A had a longer: bypass time (p=0.003), operation time (p=0.01), postoperative ventilation time (p < 0.001), ICU stay time (p=0.00125) and hospital stay time (p=0.004) compared with group B. Postoperative sepsis is higher in group A (p=0.007) compared to group B. Early mortality was 7.8% and late mortality was 6.8%. The actuarial 5-year survival rate was 85%. Six patients (5.8%) need reoperation. Cumulative incidence (Gray’s test) revealed that the preoperative unstable condition is highly significant for overall mortality (p=0.013), and also with trachea reoperation (p=0.045). Cox multivariate risk factors for overall mortality were prolonged postoperative ventilation time (HR, 3.86; 95% CI, 1.20-12.48; p=0.024), bronchoplasty required during slide tracheoplasty (HR, 5.77; 95%CI, 1.72-19.31; p=0.004) and intra-trachea-broncholitis (HR, 5.67; 95% CI, 1.51-21.31; p=0.01), whereas the preoperative unstable condition was not a risk factor. Four patients required balloon dilatation or laser granuloma treatment during a follow-up of 28.4 months (IQR, 15.3-47.3). Competing risk analysis showed at 60 months after STP operation 11.98% died without trachea reoperation, 3.6% had undergone trachea reoperation, and 73.8% were alive without trachea reoperation.

Conclusion: Intermediate-term survival for patients who underwent STP in the developing world is good, and may improve by reduced post-operative ventilation time and preventing intra-tracheo-broncholitis. A multidisciplinary approach and, in particular, early detection of patients with congenital trachea stenosis are crucial and obligatory needs to enhance this disease's long-term outcomes.

Identify the source of the funding for this research project: No funding