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Midterm outcomes of pulmonary artery sling repair with and without tracheoplasty

Published online by Cambridge University Press:  13 October 2020

Ziyad M. Binsalamah Open the ORCID record for Ziyad M. Binsalamah [Opens in a new window] ,
Alyssa Thomason ,
Christopher Ibarra Open the ORCID record for Christopher Ibarra [Opens in a new window] ,
Zachary Spigel Open the ORCID record for Zachary Spigel [Opens in a new window] ,
Iki Adachi ,
Katherine E. Barton ,
Evan Edmunds ,
Christopher A. Caldarone ,
Michiaki Imamura  and
Jeffrey S. Heinle
Ziyad M. Binsalamah*
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Alyssa Thomason
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Christopher Ibarra
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Zachary Spigel
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Iki Adachi
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Katherine E. Barton
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Evan Edmunds
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Christopher A. Caldarone
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Michiaki Imamura
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Jeffrey S. Heinle
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: Ziyad M. Binsalamah, MD, MSc, FRCSC, Division of Congenital Heart Surgery, Texas Children’s Hospital, 6651 Main street, LT19345H, Houston, TX77030, USA. Tel: +1 832 826 1929; Fax: +1 832 825 1905. E-mail: ziyadmss@gmail.com
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Abstract

Objective:

Review a single-centre experience with pulmonary artery sling repair and evaluate risk factors for re-intervention.

Methods:

Patients with surgically repaired pulmonary artery sling at a single institution between 1996 and 2018 were retrospectively reviewed. A univariate Cox regression analysis was used to evaluate variables for association with freedom from re-intervention.

Results:

Eighteen patients had pulmonary artery sling repair. At operation, median age and weight were 6.9 months (interquartile range 4.1–18.1) and 9.5 kg (interquartile range 6.5–14.5), respectively. A median hospital length of stay was 12 days (interquartile range 5.8–55.3). Twelve patients (67%) had complete tracheal rings, of whom six (50%) underwent tracheoplasty (five concurrently with pulmonary artery sling repair). Airway re-intervention was required in five (83%) of the six patients who underwent tracheoplasty. One patient had intraoperative diagnosis and repair of pulmonary artery sling during unrelated lesion repair and required tracheoplasty 24 days post-operatively. One patient died 55 days after pulmonary artery sling repair and tracheoplasty following multiple arrests and re-interventions. Median post-operative follow-up for surviving patients was 6.3 years (interquartile range 11 months–13 years), at which time freedom from re-intervention was 61%. When controlling for patient and tracheal size, initial tracheoplasty was associated with decreased freedom from re-intervention (hazard ratio 21.9, 95% confidence interval 1.7–284.3, p = 0.018).

Conclusions:

In patients with pulmonary artery sling, tracheoplasty is associated with decreased freedom from re-intervention. In select patients with pulmonary artery sling and complete tracheal rings, conservative management without tracheoplasty is feasible. Further study is necessary to delineate objective indications for tracheoplasty.

Keywords

Pulmonary artery slingcomplete vascular ringtracheal repair
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 1 , January 2021 , pp. 52 - 59
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

IRB approval: H-42751 (3/7/2018–3/5/19).

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