Metal airway stent implantation in children: Follow-up of seven children

Long segment malacia of the trachea or main stem bronchi in children is not always suitable for surgical correction; patients may therefore remain ven tilator-dependent and/or experience severe obstructive crises. We treated 7 children (ages, 4 months to 9 years) with extreme structural central airwa y obstruction with stent implantations. Six were mechanically ventilated; 5 had frequent life-threatening obstructive spells requiring deep sedation o r paralysis. Diagnoses were: syndrome-associated tracheobronchomalacia (n = 4), malignancy infiltrating the carina (n = 1), congenital tracheal stenosi s (n = 1), and tracheobronchial compression by a malpositioned aorta (n = 1 ). Six tracheal and 13 bronchial stents were endoscopically placed. The pro stheses included mesh titan (n = 5), the newer shape memory material nitino l (n = 13), and 1 Y-shaped carina stent. Follow-up was reported for 7 weeks to 72 months. All patients showed marked improvement of their respiratory obstruction. Si x children were weaned at least temporarily from ventilation. No significan t bleeding, stenosis, or perforation was observed. Seven stents were change d after up to 14 months. Three children are well and at home. In 2 children airway stabilization was successful, but they later died from causes unrel ated to stent placement. and 2 children died due to generalized airway dise ase. Soft metal mesh airway stents can offer a therapeutic option in life-threat ening inoperable obstruction of the trachea and main stem bronchi in childr en. (C) 2001 Wiley-Liss, Inc.