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.
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