Tracheal allograft reconstruction: The total North American and worldwide pediatric experiences

Background. We reviewed both the North American and the total worldwide ped iatric experience with tracheal allograft reconstruction as treatment for p atients with long segment and recurrent tracheal stenosis. Methods. The stenosed tracheal segment is opened to widely patent segments. The anterior cartilage is resected and the posterior trachealis muscle or tracheal wall remains. A temporary silastic intraluminal stent is placed an d absorbable sutures secure the chemically preserved cadaveric trachea. Aft er initial success with this technique in Europe, several North American ce nters have now performed the procedure. The cumulative North American exper ience includes 6 patients (3 adults and 3 children). Worldwide, more than 1 00 adults and 31 children, aged 5 months to 18 years, with severe long segm ent tracheal stenosis have undergone tracheal allograft reconstruction. Results. In North America, 5 of 6 patients have survived, with one early de ath due to bleeding from a tracheal-innominate artery fistula in a previous ly irradiated neck. Worldwide, 26 children survived (26 of 31 = 84%) with f ollow-up from 5 months to 14 years. Only 1 of 26 pediatric survivors (1 of 26 = 3.8%) had a tracheostomy. Conclusions. Tracheal allograft reconstruction demonstrates encouraging sho rt- to medium-term results for patients with complex tracheal stenosis. All ograft luminal epithelialization supports the expectation of good long-term results. (Ann Thorac Surg 1999;68:1043-52) (C) 1999 by The Society of Thor acic Surgeons.