Management of Severe Congenital Tracheal Stenosis

We have managed 23 infants and children with severe tracheal stenosis due to congenital complete tracheal rings producing a long-segment stenosis of the trachea. Nineteen (83%) have survived this life-threatening cause of airway obstruction, 7 of whom also had pulmonary artery slings. Pericardial patch tracheoplasty facilitated by partial cardiopulmonary bypass is currently our preferred technique for surgical repair. Eighteen patients (78%) underwent operative intervention, 3 of whom (17%) have died since surgery. The mean follow-up is 4.5 years. Bronchoscopy is essential for preoperative diagnosis and accurate intraoperative incision of the trachea, and is critical for long-term postoperative airway management. The more distal lesions are associated with increased complications and a higher mortality rate.