Day of Thoracic Tracheoplasty Surgery

What to expect day of surgery

Children born in severe respiratory distress and/or heart failure may require immediate surgery. Most patients and their families, however, have some time to prepare. In every case, the cardiac anesthesiologists work hand-in-hand with the otolaryngology airway reconstruction team to evaluate the airway, anticipate any complications for patients with airway abnormalities, and manage any unexpected tracheal narrowing identified during the surgery itself. At the beginning of surgery, the airway team typically places a breathing tube in the patient where it won’t aggravate the complete tracheal ring segments requiring repair.

The cardiothoracic (CT) surgery team then opens the patient’s chest and places him or her on a heart-lung bypass machine to maintain normal blood flow to the body without depending on the lungs or heart during surgery. Bypass is sometimes required because the lung or heart components of the surgery necessitate it and sometimes because the tracheal repair itself requires full airway access by the surgeon.

Once the patient is safely on the bypass machine, the CT team performs the cardiac repair.

When the CT team has completed the cardiac or vascular operations, the otolaryngology team returns and removes the breathing tube to gain full access to the trachea. They endoscopically confirm their airway measurements and then horizontally transect the trachea in the middle of the narrowing created by the rings. They vertically cut the lower segment of the trachea (and sometimes the bronchi that go down into the lungs) along the back portion and then vertically cut the upper segment of the airway, which may extend all the way up to the larynx. The surgeon slides the lower portion of the trachea over the upper portion to create a much wider and somewhat shorter trachea. Unlike older forms of tracheoplasty, the slide procedure does not require resection of trachea. It often shortens surgery time and, compared with older techniques, reduces both risk of complication and recovery time. Performing both parts simultaneously reduces the number of surgeries required to address the cardiovascular and tracheal repairs.

The surgery can take anywhere from three to 12 hours, depending mainly on the complexity and extent of the cardiac repairs.