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.
Type: video · 0 min · posted 2025-04-29 Canonical: https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435 ## Chapters - [0:00](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=0) Tracheobronchopexy Outcomes in Esophageal Atresia Patients ## Statements - "Esophageal atresia patients often have tracheobronchomalacia" — Lizzie Lee (clinical) [0:13](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=13) - "Tracheobronchomalacia can cause serious breathing problems like blue spells in esophageal atresia patients" — Lizzie Lee (clinical) [0:13](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=13) - "The study reviewed 80 esophageal atresia patients who underwent tracheobronchopexy at two hospitals between 2013 and 2021" — Lizzie Lee (epidemiological) [0:23](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=23) - "94% of esophageal atresia patients who underwent tracheobronchopexy were able to avoid tracheostomy" — Lizzie Lee (clinical) [0:33](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=33) - "Tracheobronchopexy significantly reduced life-threatening breathing events in esophageal atresia patients" — Lizzie Lee (clinical) [0:38](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38) - "Tracheobronchopexy significantly reduced the need for positive pressure ventilation in esophageal atresia patients" — Lizzie Lee (clinical) [0:38](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38) - "Tracheobronchopexy significantly reduced ventilator dependence in esophageal atresia patients" — Lizzie Lee (clinical) [0:38](https://library.globalcastmd.com/watch/tracheobronchopexy-to-avoid-tracheostomy-in-esophageal-atresia-patients-with-severe-life-threatening-tracheobronchomalacia-10435?t=38) ## Transcript Can performing a tracheobronchopexy help oesophageal atresia patients with severe tracheobronchoalacia avoid getting a tracheostomy? I'm Lizzie Lee from Cincinnati Children's, and this is an article you should know about. This was a retrospective observational study of esophageal atresia patients, who often have tracheal bronchoomalacia, which can cause serious breathing problems like blue spells. The review looked at 80 esophageal atresia patients who underwent tracheal bronchopexy at two hospitals between 2013 and 2021. They found that 94% of these patients were able to avoid a tracheostomy. The surgery significantly reduced life-threatening breathing events, the need for positive pressure ventilation, and ventilator dependence. Let us know what you think in the comments below and stay tuned for more articles that you should know about. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai