External Stenting Relieves Pediatric Chronic Airway Obstruction

By HospiMedica International staff writers
Posted on 31 May 2016

A novel technique known as external stenting (ES) expands and stabilizes the airway in children by suspending it on a rigid prosthesis placed around the bronchus or trachea.

Developed by researchers at Sakakibara Heart Institute (Tokyo (Japan), the ES technique suspends the airway on two separate oversized ring-reinforced polytetrafluoroethylene prosthesis in order to both expand and stabilize the airway in small children suffering from chronic airway obstruction. The technique avoids the common problem of granulation formation that results from endolumenal corrective approaches, such as endoscopic stent placement.

Image: The scheme of the external stent technique. Ringed PTFE graft, involving three to five rings, is used. The larger piece stabilizes the cartilage portion using three rows of stitches and a smaller one for the membrane portion (single row). The two graft pieces are overlapped by a few millimeters and not sewn to each other (Photo courtesy of the Sakakibara Heart Institute).

From April 1997 to July 2015, 98 children (43 female and 55 male, median birth weight 2.7kg) underwent ES at Sakakibara Heart Institute, with the median age at the first operation being 7.2 months, and cardiovascular anomalies were noted in 82 children, with 18 having aortic arch obstruction, while 14 children had functional single ventricular hearts and were expecting future Fontan operations. Eight of the patients had previously undergone an unsuccessful aortopexy.

In all, the patients underwent a total of 127 ES procedures, with 14 mortalities. Of the 84 survivors, 88.1% were successfully weaned from the ventilator at a median of five days. The negative pressure threshold to induce airway collapse was measured for 58 procedures for congenital malacia, and showed improved stability of the airway. A follow-up computerized tomography (CT) in 23 patients two years after intervention showed the diameter of the stented area was almost equal to that of the age-matched control. The study was presented at the 96th AATS annual meeting, held during May 2016 in Baltimore (MD, USA).

“Our ES technique may provide an alternative or adjunct to established practices for relieving airway obstruction, such as aortopexy,” said lead author and study presenter Makoto Ando, MD, of the department of pediatric cardiac surgery. “ES is less invasive and more reliable, and is effective equally for tracheobronchomalacia with or without vascular compression. It also has the potential of allowing age proportional growth of the airway.”

An airway obstruction manifested during early childhood can be life threatening, and is also frequently associated with congenital cardiovascular anomalies. Incomplete relief of the obstruction may lead to obstructive pulmonary vascular disease, which is unfavorable for patients with congenital heart disease (CHD).

Related Links:
Sakakibara Heart Institute