Division Chief, Pediatric Otolaryngology Rady Children's Hospital San Diego / UCSD University of California San Diego San Diego, California
Introduction: Severe tracheobronchomalacia can require prolonged mechanical ventilation and be life-threatening. Effective treatment remains elusive. Endoluminal airway stenting has historically been associated with poor outcomes due to erosion and granulation formation. Advances in stenting technology have provided a renewed role in the viability of such stents in children with severe airway malacia.
Methods: A retrospective review of children with complex airway disease evaluated and treated in the cardiac catheterization lab with the placement of airway stents over the course of 3 years was performed. A multi-disciplinary complex airway team (otolaryngology, interventional cardiology, pulmonology and cardiothoracic surgery) evaluated patients using laryngoscopy, bronchoscopy, fluoroscopy, and contrast bronchography.
Results:Evaluation and stenting of nine children in the cardiac catheterization lab was successful in all patients attempted. All cases involved severe bronchomalacia or tracheomalacia that was refractory to conservative therapy. There were no procedural adverse events and there were no complications at most recent follow up (mean 13 months, range 1-44 months). There was sufficient stent radial strength to relieve tracheobronchomalacia without causing erosion.
Conclusion: In cases of severe bronchomalacia and tracheomalacia, airway stenting with properly selected cardiovascular soft bare metal stents was effective in relieving malacia with minimal morbidity.