Tracheobronchopexiy to Avoid Tracheostomy in Esophageal Atresia (EA) Patients With Severe Life-Threatening Tracheobronchomalacia (TBM) | Feb 2013 - Sep 2021 | 80 EA patients | Retrospective cohort | underwent 91 tracheobronchopexies | Surgical approach for tracheobronchopexiy: | - Posterior (73 %) - Anterior (23 %) - Simultaneous posterior+anterior (4 %) | There were | • no recurrent blue spells/BRUEs (p < 0.001) | • significantly reduced PPV | • ventilator dependence (p < 0.001) | 94% of all patients avoided tracheostomy. | Mortality = 5% | Conclusion: In esophageal atresia patients with severe life-threatening tracheobronchomalacia, tracheobronchopexiy reduces blue spells, PPV, ventilator dependence, and avoids tracheostomy, making it the preferred treatment. | https://pubmed.ncbi.nlm.nih.gov/39826297/ | Shieh HF et al. | Division of Specialized Care, Department of Surgery, Johns Hopkins All Children's Hospital, FL, United States | Journal of Pediatric Surgery | @EmGooteeMD | @globalcastmd | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's
Tracheobronchopexy to Avoid Tracheostomy in Esophageal Atresia Patients With Severe Life-Threatening Tracheobronchomalacia
Infographic · Jun 2025 · 1 min read
In brief
In brief
Study of 80 esophageal atresia patients demonstrates that tracheobronchopexy effectively treats severe life-threatening tracheobronchomalacia, eliminating blue spells/BRUEs and enabling 94% to avoid tracheostomy. Median 39-month follow-up shows sustained reduction in ventilator dependence with 5% mortality related to underlying comorbidities.
- Tracheobronchopexy eliminated blue spells/BRUEs in EA patients with severe TBM and avoided tracheostomy in 94% of cases.
- 90% of patients had complete airway collapse on preop bronchoscopy; posterior approach was most common surgical technique (73%).
- Significant reduction in PPV and ventilator dependence post-op with 5% mortality, mostly related to comorbidities not the procedure.
- Median age at surgery was 6 months; most patients (92.5%) had Gross type C EA with life-threatening TBM requiring intervention.
- Tracheobronchopexy should be considered first-line treatment for severe life-threatening TBM in EA patients before tracheostomy.
Written by the GCMD Library team from the infographic.
The infographic uses a teal, gray, and yellow color scheme with illustrated children figures in the header section. A calendar icon appears on the left, and an anatomical diagram of a child's airway is shown on the right side. The layout flows from top to bottom with key statistics highlighted in colored text boxes.
Hester F. Shieh, Russell W. Jennings, Thomas E. Hamilton, ∙ Shawn Izadi, ∙ Benjamin Zendejas, C. Jason Smithers
Background
Esophageal atresia (EA) is associated with tracheobronchomalacia (TBM), which in its most severe form, causes blue spells, brief resolved unexplained events (BRUEs) that can require cardiopulmonary resuscitation (CPR), and positive pressure ventilation (PPV) or ventilator dependence, often requiring tracheostomy. We study the role of tracheobronchopexy, as an alternative to tracheostomy, in EA patients with severe life-threatening TBM.
Methods
We reviewed EA patients who underwent tracheobronchopexy for blue spells, BRUEs, and failure to wean PPV or extubate from February 2013 to September 2021 at two institutions. Patient characteristics, surgical techniques, and respiratory outcomes were reviewed.
Results
80 EA patients (most Gross type C 92.5 %) underwent 91 tracheobronchopexies at median age 6 (IQR 3–14) months for blue spells/BRUEs (53 %), PPV (21 %), and ventilator dependence (26 %). On preoperative dynamic bronchoscopy, most (90 %) demonstrated complete airway collapse. Surgical approach for tracheobronchopexy was posterior (73 %), anterior (23 %), and simultaneous posterior and anterior (4 %). Tracheobronchopexy included thoracic trachea alone (58 %), trachea and bronchi (41 %), and bronchi alone (1 %). At latest follow up of median 39 (IQR 14–64) months, there were no recurrent blue spells/BRUEs (p < 0.001) and significantly reduced PPV and ventilator dependence (p < 0.001). Nearly all patients (n = 75, 94 %) avoided tracheostomy. Mortality was 5 %, one 30-day operative mortality and three long-term mortalities related to underlying comorbidities.
Conclusions
In EA patients with severe life-threatening TBM, tracheobronchopexy significantly reduces blue spells/BRUEs, PPV, and ventilator dependence, and avoids tracheostomy. This surgical strategy should be considered the treatment of choice for EA patients with severe life-threatening TBM symptoms.