• Xin-Wei Du, Peng-Hui Wang, Hao Wang, Dan-Wei Zhang, Qiang Chen, Zhi-Wei Xu, Li-Min Zhu, Zhao-Hui Lu, and Shun-Min Wang.
• Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
• J. Thorac. Cardiovasc. Surg. 2024 Aug 17.

ObjectiveTo examine the safety and effectiveness of proactive tracheoplasty for pediatric ring-sling complex.MethodsWe retrospectively collected data from 304 children who were diagnosed with a ring-sling complex and underwent surgery at 3 cardiac centers in China between January 2010 and June 2023. The children were categorized into 3 surgical groups: concurrent sling and tracheal surgery (group A; n = 258), staged sling and tracheal surgery (group B; n = 25), and sling-only surgery (group C; n = 21). We compared perioperative clinical characteristics, tracheal morphology changes, and outcomes across the 3 groups.ResultsThe median age of the children was 1.2 years (interquartile range, [IQR], 0.7-1.9 years). The anomalous tracheobronchial arborization rates were higher in group A (52.5%) and group B (60.0%) compared to group C (15.0%). The preoperative narrow-wide ratio (NWR) was lower in groups A and B than in group C, with values of 0.44 (IQR, 0.35-0.52), 0.44 (IQR, 0.33-0.59), and 0.68 (IQR, 0.54-0.72), respectively (P < .001). Preoperative subcarina angles were similar among the groups (P = .54). After specific surgeries, the NWR and subcarina angle were improved significantly in groups A and B but not in group C. There were 7 in-hospital deaths and 2 postdischarge deaths. Respiratory symptoms improved in groups A and B, but 7 children in group C remained in respiratory dysfunction. Six children presented with residual stenosis of the left pulmonary artery.ConclusionsConcurrent sling and tracheal surgeries for children with the ring-sling complex are safe and effective and are especially preferable for those with NWR ≤0.6, long-segment or diffuse tracheal stenosis, anomalous tracheobronchial arborization, and pronounced respiratory symptoms.Copyright © 2024. Published by Elsevier Inc.

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