One slide fits all: The versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children

Objectives: This study describes results of tracheal reconstruction in children with slide tracheoplasty with cardiopulmonary bypass and identifies predictors for adverse outcomes. Methods: Preoperative characteristics, operative variables, and outcome measures were collected for children undergoing slide tracheoplasty with cardiopulmonary bypass between April 2001 and October 2009. Predictors of worse outcomes were identified by bivariate analysis. Multiple regression analysis was performed for predictors of prolonged hospital stay. Results: Cohort included 80 patients (median age, 8.7 months; 7 days-21 years). Forty-eight patients had associated cardiac or great vessel anomalies; 24 had simultaneous repair of cardiovascular anomaly at tracheal reconstruction. Fifty (63%) were extubated within 48 hours after operation. Median stay was 18.5 days (range, 7-119 days). Twenty-three patients (29%) required significant airway reintervention during median follow-up of 12 months (range, 4 months-7.8 years). There were 4 deaths, 2 early and 2 late. In bivariate analysis, age (P = .017), cardiopulmonary bypass duration (P = .025), and duration of mechanical ventilation (P < .05) were associated with mortality; duration of postoperative mechanical ventilation was associated with need for significant airway reintervention (P = .009). Multiple regression analysis indicated preoperative ventilatory support (P < .001), longer cardiopulmonary bypass (P = .002), previous airway operation (P = .01), and need for significant airway reintervention (P < .001) as predictors of longer hospital stay. Conclusions: Slide tracheoplasty with cardiopulmonary bypass can be performed with low mortality in a diverse pediatric population. This technique minimizes need for early significant airway reintervention in most cases.