• Emmeline E Calkoen, Hany O S Gabra, Derek J Roebuck, Edward Kiely, and Martin J Elliott.
• Tracheal Service and Cardiorespiratory Directorate, Great Ormond Street Hospital for Children, London, UK. ecalkoen@gmail.com
• Pediatr Crit Care Me. 2011 Sep 1;12(5):545-51.

ObjectivesTo define the factors influencing the outcome of aortopexy as management of tracheo-bronchomalacia.DesignA retrospective, single-center, observational, cohort study.SettingsSurgical services in a tertiary care hospital.PatientsOne hundred five children who underwent an aortopexy for tracheo-bronchomalacia between 1990 and 2008.InterventionsNone.Measurements And Main ResultsComorbidity (categorized into three groups), surgical approach, and location of malacia were reviewed and analyzed in relation to mortality, need for a second intervention, complications, time to extubation after surgery, intensive care unit stay, and clinical improvement. Median age at surgery was 24 wks (1 wk-541 wks). Two surgical approaches were used: median sternotomy (n = 46) and left anterior parasternal (n = 59). Long-term (>2 yrs) follow-up was available for 73 patients (median = 7.0 yrs [2-18 yrs]); 73% were asymptomatic, 18% had minor symptoms, and 9% needed either ventilation or tracheostomy. The overall mortality rate was 9%, of which one-third was airway-related. Multivariable analysis revealed that major comorbidities were a significant risk factor both for mortality and the need for further procedures (re-do surgery, tracheostomy, internal stents) in contrast to surgical approach and involvement of the bronchus. Intensive care unit stay and days of ventilation after surgery were also significantly higher in patients with major comorbidities.ConclusionsAortopexy proved to be an effective treatment for most cases of tracheo-bronchomalacia, but major comorbidity was associated with an adverse outcome. Our data suggest that aortopexy should be considered in most cases of severe tracheo-bronchomalacia.

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