EN
TÜRKÇE
Poster - 31
Tracheomalacia and airway obstruction among infants with esophageal atresia with/without tracheoesophageal fistula.
E Lapidus-Krol*, E Propst*, N Wolter*, J Siu*, P Campisi*, O Honjo*, T Moraes*, M Marcon*, M Gould*, P Chiu**
*The Hospital for Sick Children
**The Hospital for SIck Children and University of Toronto
Background: Infants with esophageal atresia with/without tracheoesophageal fistula (EA/TEF) may develop significant upper airway obstruction from tracheomalacia (TM) necessitating surgical intervention such as aortopexy, tracheopexy and, in rare cases, tracheostomy. This review is to assess airway procedures and outcomes of symptomatic TM for EA/TEF patients.
Methods: Single centre REB approved retrospective chart review of EA/TEF patients repaired from Jan. 1, 2000 to Nov. 30, 2024 was performed. Airway obstruction was defined as clinically documented respiratory distress, desaturation with stridor and/or brief resolved unexplained event. TM and severity of airway obstruction were confirmed by imaging and/or bronchoscopy. Patient demographics including gestational age, EA/TEF type and surgical procedures were collected. Statistical analyses were performed using SPSS® 2.0.
Results: In total, 49 of the 423 (11.6%) EA/TEF patients had airway obstruction with 45 due to TM. Patients who were premature (<37 weeks’ gestation at birth) were more likely to have airway obstruction (p = 0.004, Fisher’s exact test). Of the 45 patients, 19 required airway procedures: 1 had airway stent deployment that was removed 5 years later, 10 had aortopexies, 7 patients required combined aortopexy and posterior tracheopexy and 1 required aortopexy and descending aortopexy. Of the 10 aortopexy patients, 6 also required additional fundoplication procedure for complete resolution of their symptoms. One of the 7 aortopexy and posterior tracheopexy patients required re-do aortopexy; another had re-do aortopexy/tracheopexy without improvement, resulting in tracheostomy at 4.8 months of age. One patient had aortopexy with resolution of all respiratory symptoms but died at home 10 months post-aortopexy- post mortem did not reveal airway obstruction as cause of death. There were no other deaths in this cohort.
Conclusion: Airway obstruction is a challenging condition to treat among EA/TEF infants. A multi-disciplinary approach to the interventions to definitively relieve symptomatic obstruction is required.