REPAIR OF CONGENITAL TRACHEAL STENOSIS WITH A FREE TRACHEAL AUTOGRAFT

Objectives: Evaluate the results of a technique for repair of congenit al tracheal stenosis by use of a free tracheal autograft, Methods: Bet ween January 1996 and July 1997, six infants with congenital tracheal stenosis resulting from complete tracheal rings underwent repair,vith a free tracheal autograft. Mean age at the time of repair was 4.9 mont hs; mean weight was 5.4 kg, The approach was through a median sternoto my with cardiopulmonary bypass for respiratory support. The trachea wa s incised anteriorly through the area of stenosis, the midportion of t he stenotic trachea was excised, and an end-to-end anastomosis was car ried out posteriorly, The excised tracheal segment (1.3 to 2.2 cm long ) was used as a free autograft to patch the lower trachea anteriorly. In four infants the autograft was augmented in the upper trachea with pericardium; in tao patients with a shorter length of stenosis, the au tograft completed the repair. Simultaneous pulmonary artery sling repa ir (4), ligation and division of patent ductus arteriosus (3), cricoid split (2), atrial and ventricular septal defect repair (1), and compl ete atrioventricular canal repair (1) were performed at the time of tr acheal repair, Results: The infants were extubated and discharged at a mean of 13 and 23 days postoperatively, respectively. One infant had recurrent tracheal stenosis related to the pericardial patch and requi red a tracheal stent and tracheostomy ii months postoperatively. Our m ean follow-up is 11 months. Bronchoscopic findings currently show wide ly patent tracheal lumina in all infants. Conclusions: The technique o f free tracheal autograft with and without pericardial augmentation wa s successful in opening the airway of six infants with congenital trac heal stenosis and is currently our procedure of choice for children wi th this diagnosis.