Congenital Tracheal Stenosis: Tracheal Autograft Technique

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Presentation transcript:

Congenital Tracheal Stenosis: Tracheal Autograft Technique Carl Lewis Backer, MD, Lauren D. Holinger, MD, Constantine Mavroudis, MD Operative Techniques in Thoracic and Cardiovascular Surgery Volume 12, Issue 3, Pages 178-183 (September 2007) DOI: 10.1053/j.optechstcvs.2007.06.001 Copyright © 2007 Elsevier Inc. Terms and Conditions

Figure 1 (A) This illustration is the index case which led to our interest in using the tracheal autograft. The child has complete tracheal rings from the third tracheal ring to the carina. With the child on cardiopulmonary bypass, the trachea was incised anteriorly from just below the cricoid cartilage to the carina. In an effort to improve the outcome of the pericardial tracheoplasty, the midportion of the tracheal stenosis was resected to shorten the trachea. (B) A posterior end-to-end anastomosis was performed with interrupted PDS sutures. The pericardial patch was then trimmed appropriately and sutured in place with interrupted PDS sutures. Operative Techniques in Thoracic and Cardiovascular Surgery 2007 12, 178-183DOI: (10.1053/j.optechstcvs.2007.06.001) Copyright © 2007 Elsevier Inc. Terms and Conditions

Figure 2 This illustration shows how a tracheal homograft can be used to repair a residual tracheal stenosis after tracheal resection with resultant residual stenosis. The homograft has been harvested from a cadaver, fixed in formalin, washed in methiolate and alcohol, and stored in acetone. The similarity of the tracheal homograft to the piece of trachea that was resected and shown in Figure 1A and that was originally discarded at that time is striking. (From Jacobs JP, Elliott MJ, Haw MP, et al: Pediatric tracheal homograft reconstruction: a novel approach to complex tracheal stenoses in children. J Thorac Cardiovasc Surg 112:1549-1558, 1996.) Operative Techniques in Thoracic and Cardiovascular Surgery 2007 12, 178-183DOI: (10.1053/j.optechstcvs.2007.06.001) Copyright © 2007 Elsevier Inc. Terms and Conditions

Figure 3 The first tracheal autograft we performed as mentioned in the text was on a 2-month-old, 4.5 kg child that also had a pulmonary artery sling repair and ventricular septal defect closure immediately before the tracheal procedure. (A) On cardiopulmonary bypass the anterior trachea was incised as indicated by the dotted line. The midportion of complete tracheal rings was resected. This entailed seven complete tracheal rings. (B) A posterior end-to-end anastomosis was then created as shown in the far left panel. The portion of the trachea that was used as an autograft was then trimmed as shown in the lower middle panel. This tracheal autograft was inserted into the distal trachea and sutured in place with interrupted PDS sutures. An autologous pericardial patch was then trimmed as shown and used to augment the upper portion of the trachea. This was sutured in place with interrupted PDS sutures. Operative Techniques in Thoracic and Cardiovascular Surgery 2007 12, 178-183DOI: (10.1053/j.optechstcvs.2007.06.001) Copyright © 2007 Elsevier Inc. Terms and Conditions

Figure 4 We had several cases with a long segment congenital tracheal stenosis that we felt was too long to have a successful resection, but short enough that the autograft could be used to complete the repair without pericardial augmentation. (A) On cardiopulmonary bypass the trachea is incised through the length of the tracheal stenosis. The autograft is resected as shown in the middle panel. One of the benefits of the autograft technique is that precise definition of the midportion of the stenosis is not required as the incision can be carried inferiorly and superiorly until normal membranous trachea is encountered. Usually this incision must be taken into at least one or two normal tracheal rings for correct augmentation of the tracheal lumen. (B) A posterior end-to-end anastomosis is created with interrupted PDS sutures. The autograft is trimmed at all four corners as shown in the middle panel and then inserted in the resultant anterior orifice remaining in the trachea. The autograft is sutured in place with interrupted PDS suture. The tracheal repair has been completed without pericardial augmentation. Operative Techniques in Thoracic and Cardiovascular Surgery 2007 12, 178-183DOI: (10.1053/j.optechstcvs.2007.06.001) Copyright © 2007 Elsevier Inc. Terms and Conditions