Tracheal reconstruction in children using cadaveric homograft trachea

Abstract

OBJECTIVE: We report the use of cadaveric human tracheal homograft inthe treatment of severe long segment congenital tracheal stenosis inchildren. METHODS: Five children (aged 5 months-8 years) with severelife-threatening airway obstruction due to long segment congenital trachealstenosis had failed conventional management. All were ventilator dependentor rapidly deteriorating at the time of surgery, two were on extracorporealmembrane oxygenation, and no alternative therapy was available. Thestenosed trachea was removed and the posterior trachealis muscle left insitu when possible. Surgical technique involved the use of cardiopulmonarybypass in four of five cases. Stored cadaveric tracheal homograft tissuewas shaped and inserted over a silastic intra-luminal stent which was keptin place for up to 3 months. Regular bronchoscopy was necessarypostoperatively to clear granulation tissue, which resolved on removal ofthe stent. RESULTS: Four patients are all now without stents, intubation ortracheostomy. Three are without airway problems 16, 14, and 9 months aftersurgery and one attends for occasional dilatation of a distal trachealstenosis, but is now at home despite other severe multiple congenitalproblems. One patient presented with complete disruption of the trachea andmediastinal sepsis and was supported on extracorporeal membrane oxygenationprior to surgery; this patient eventually died of airway failure andsepsis. CONCLUSIONS: The application of cadaveric human tracheal homograftto congenital tracheal stenosis is novel. Its use in five children whowould otherwise have died has provided an extra therapy in an extremelydifficult group of patients.