Posterior Tracheopexy For Severe Tracheomalacia

The paper by first author Hester Sche and last author Russell Jennings examined 98 patients who had severe tracheomalacia with posterior membranous intrusion.

All patients received bronchoscopy showing the trachea tended to collapse inward from the posterior aspect.

The authors distinguished between anterior compression (from the aortic arch) and posterior compression (collapse).

Posterior tracheopexy involves taking pledgeted sutures and sewing the posterior wall of the trachea to the anterior longitudinal ligament of the spine.

88% of the 98 patients had esophageal atresia with or without TEF.

Patients were followed anywhere from 1 week to 36 months.

Clinical symptoms including cough, barking cough, noisy breathing, and infections improved across the board.

Patients improved on bronchoscopic evaluation.

Exercise tolerance did not improve statistically but showed a trend towards improvement.

Tracheomalacia is not a homogeneous disease.

The paper emphasized the importance of systematic bronchoscopic evaluation.

Some patients benefit from posterior tracheopexy, some from aortopexy or anterior approach, and some need both.

Approximately 20% of patients in the study required both posterior tracheopexy and aortopexy.