Pay Your Dues Members Only Area
Central Surgical Association

49th Annual Meeting

Back to 2022 Abstracts

Outcomes of pulmonary artery sling repair without tracheoplasty: pattern and associated factors of hospital readmission
Eun Seok Choi, Chun Soo Park, Dong-Hee Kim, Bo Sang Kwon, Tae-Jin Yun
Asan medical center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)

Objective: The ideal management for PA sling remains controversial. This study aimed to investigate surgical outcomes of PA sling without tracheoplasty.
Methods: We retrospectively reviewed the data of 22 patients who underwent PA sling repair between 2001 and 2020. The left PA was reimplanted in all patients. Although 19 (86.4%) patients had airway symptoms preoperatively, concomitant tracheal surgery was avoided for all but 1 patient. The median age and body weight at repair were 7.3 months (interquartile range [IQR], 3.1-22.0months) and 7.4kg (IQR, 4.4-11.9kg), respectively. The narrowest preoperative tracheal diameter was measured using computed tomography as the mean diameter of 2 perpendicular axes at the narrowest level. Cox regression analysis was performed to identify associated factors with readmission in univariate analysis. Maximal chi-square method was used to determine optimal cutoff point of associated factor with hospital readmission.
Results: There was 1 (4.5%) in-hospital death. The median postoperative ventilator time and intensive care unit length of stay were 23.0 hours (IQR, 12.0-224.0hours) and 3 days (IQR, 1.0-14.0days), respectively. At a median of 6.9 years of follow-up, there were no late death and no tracheal intervention. Hospital readmission for respiratory symptoms was required for 7 patients. Freedom from readmission was 64.6% at 5 years. Readmission was not required for any patients after 2 postoperative years. In univariate analysis, the narrowest preoperative tracheal diameter was associated with hospital readmission (hazard ratio, 0.33; 95% confidence interval, 0.23-0.89; P=0.029). The hospital readmission rate was significantly higher among patients whose narrowest preoperative tracheal diameters ≤ 3.6mm (P=0.003).
Conclusions: PA sling repair without tracheoplasty is a reasonable surgical option in terms of mortality. Hospital readmission for respiratory distress may be required in selected patients until 2 years after repair. The narrowest preoperative tracheal diameter is associated with hospital readmission after repair.

Summary of patients

Factors associated with hospital readmission for respiratory symptoms after pulmonary artery sling repair without tracheoplasty (n = 20)

Computed tomographic images showing pulmonary artery sling with tracheal stenosis. (A) Axial image showing pulmonary artery sling, (B) 3-dimensional reconstructed image showing stenotic tracheobronchial tree with bridging bronchus

(A) Kaplan-Meier curve, and (B) hazard function for hospital readmission resulted from respiratory symptoms after pulmonary artery sling repair without tracheoplasty.

(A) The serial changes of the narrowest tracheal diameter measured using CT in patients who underwent pulmonary artery sling repair without tracheoplasty. (B) The serial changes in 2 months after repair under magnification.

Back to 2022 Abstracts