Congenital: Pulmonary Artery
Outcomes of pulmonary artery sling repair without tracheoplasty

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Abstract

Objective

This study aimed to investigate surgical outcomes of pulmonary artery (PA) sling without tracheoplasty.

Methods

From 2001 through 2020, among 22 patients who underwent PA sling repair, all but 1 patient who underwent concomitant tracheal surgery were analyzed. The outcomes of interest were all-cause death, PA reintervention, tracheal intervention, and readmission for respiratory symptoms. Computed tomography was used to measure the narrowest tracheal diameter.

Results

The median age and weight at repair were 7.6 months and 7.7 kg, respectively. Most patients (20 out of 21, 95.2%) had preoperative respiratory symptoms. Associated airway anomalies included tracheal ring in 12 (57.1%), bridging bronchus in 8 (38.1%), and tracheal bronchus in 2 patients (9.5%). There was 1 in-hospital death (4.8%). The median ventilator time and intensive care unit stay were 23 hours and 3 days, respectively. There was neither late death nor tracheal intervention during follow-up. Five patients (25.0%) underwent reintervention for left PA stenosis. Hospital readmission for respiratory symptom was required in 7 patients and was associated with the narrowest preoperative tracheal diameter (P = .025) and cardiopulmonary bypass time (P = .040) in univariable analysis. The narrowest tracheal diameter of 3.4 mm was identified as a cutoff value for readmission for respiratory symptom. Freedom from readmission for respiratory symptom was 63.3% at 10 years.

Conclusions

PA sling repair without tracheal surgery might be a reasonable surgical option with rare need for tracheal intervention. Hospital readmissions for respiratory symptoms are more frequently required in patients with smaller tracheal diameter and all readmissions were limited to within 2 years after repair.

Section snippets

Patients

From 2000 to 2020, 22 patients who underwent PA sling repair were included in this study. One patient during the contemporaneous study period underwent successful tracheoplasty (1 out of 22; 4.5%), but was otherwise excluded from further analysis. Data collection, collation, and analysis were approved by the relevant institutional review board (No. S2020-2998-0003; approval date: January 11, 2022), and the need for informed consent was waived because of the retrospective nature of the study.

Baseline Characteristics

Patient characteristics are summarized in Table 1. There were 12 boys (57.1%). The median age and body weight at repair were 7.6 months (IQR, 2.5-22.2 months) and 7.7 kg (IQR, 4.3-12.2 kg), respectively. Most patients (20 out of 21; 95.2%) had respiratory symptoms before repair. Seven patients (33.3%) had associated major cardiac defects, including ventricular septal defect (n = 2), coarctation of the aorta (n = 2), partial atrioventricular septal defect (n = 1), tetralogy of Fallot (n = 1),

Discussion

PA sling was first recognized by Glaevecke and Doehle in 1897,6 and the term sling was coined to distinguish this disease entity from a vascular ring by Contro and colleagues.7 Cohen and Landing8 first noted the association between PA sling and tracheal stenosis in 1976. Given the high prevalence of complete tracheal ring in patients with PA sling, Berdon and colleagues9 first introduced the term ring-sling complex in 1984. Because respiratory complications frequently occurred after repair of

Conclusions

PA sling repair without tracheal surgery might be a reasonable surgical option with rare need for tracheal intervention. Hospital readmissions for respiratory symptoms were more frequently required in patients with smaller tracheal diameter and all readmissions were limited to within 2 years after repair (Figure 5).

References (24)

  • R.D. Hobbs et al.

    Novel suture technique for slide tracheoplasty for the treatment of long-segment tracheal stenosis

    Semin Thorac Cardiovasc Surg

    (2020)
  • M.C. McInnis et al.

    Advanced technologies for imaging and visualization of the tracheobronchial tree: from computed tomography and MRI to virtual endoscopy

    Thorac Surg Clin

    (2018)

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