The Outcomes of Slide Tracheoplasty for Complete Tracheal Rings in Children With a Tracheal Bronchus

Objective To compare airway presentation and outcomes following slide tracheoplasty for congenital tracheal stenosis with complete tracheal rings in children with and without a tracheal bronchus. Study Design Retrospective cohort study. Setting Quaternary pediatric referral center. Methods Children undergoing slide tracheoplasty for complete tracheal rings between 2001 and 2021 were included. Clinical variables and outcomes were compared by tracheal bronchus status. Propensity score matching was performed to adjust for baseline differences. Operative success was defined as a symptom‐free, non‐tracheostomy‐dependent airway. Results Among 160 children, 64 (40.0%) had a tracheal bronchus. Children without a tracheal bronchus presented at a younger age (median 184 vs 432 days; P = .014) and more frequently had stenosis involving >80% of the trachea (40.6% vs 12.5%; P = .0005) and bronchial extension (28.1% vs 12.5%; P = .032). Preoperatively, children without a tracheal bronchus were more often mechanically ventilated (49.0% vs 29.7%; P = .023) and had higher rates of cardiopulmonary arrest (15.6% vs 1.56%; P = .008). Postoperatively, they experienced longer ventilation (median, 41.5 vs 24 hours; P = .030), longer intensive care unit stay (13.5 vs 6 days; P = .005), and higher rates of bronchial stenosis (34.4% vs 14.1%; P = .0074). Operative success was higher in the tracheal bronchus group (92.2% vs 78.1%; P = .035). After propensity matching, no differences were observed in operative success (82.0% vs 90.0%; P = .815). Conclusion A tracheal bronchus was associated with a less severe airway presentation. Modification of the slide tracheoplasty technique to accommodate the aberrant bronchus does not have inferior outcomes.