Management of congenital tracheal stenosis in infancy

We read with great interest the article of Anton-Pacheco et al. [1] in which they analyzed 19 cases with congenital tracheal stenosis. This single center study consisted of different groups of patients, classified to the severity and length of the tracheal stenosis. The authors described three different surgical techniques with an overall mortality rate of 21%. The rate of mortality in Anton-Pacheco’s series exceeds clearly all contemporary standards published in the literature in the last decade [2] (early mortality 6% and late mortality 12%). The authors reported excellent results with slide tracheoplasty in 7 patients but very poor clinical outcome with costal cartilage tracheoplasty. Cardiopulmonary bypass (CPB) was used in all patients with slide tracheoplasty but only occasionally in cases using the cartilage tracheoplasty and in cases presenting with short segment stenosis. According to our experience based on 37 patients with tracheal pathology, isolated or associated with congenital heart malformations the use of CPB in the surgical management of these patients is very useful and represents an effective tool. In our hands the survival rate was 97% despite of the associated cardiovascular malformations, higher percentage of redo procedures and the complexity of surgical interventions. We attempted surgical treatment of tracheal pathology with simultaneous repair of congenital cardiac lesions inmost of the cases [3]. The crucial part of our surgical technique regarding the tracheal part of the operation was careful dissection and mobilization of the trachea, main bronchi, pulmonary arteries and veins in order to obtain tension-free tracheal anastomosis. In our experience the key element in the surgical approach for such patients represents the use of CBP which allowed extensive mobilization of the whole tracheobronchial tree and resection of the trachea with end-to-end tension free