Tracheopexy for Severe Tracheobronchomalacia in Children with Bronchopulmonary Dysplasia: A Two-Center Study of Patient Characteristics and Outcomes.

PURPOSE: The aim of this study was to characterize clinical phenotypes of children with severe tracheobronchomalacia (TBM) and bronchopulmonary dysplasia (BPD), report our experience with surgical management, and review outcomes. METHODS: We retrospectively reviewed children <3 years old with BPD undergoing surgical management of severe TBM at two pediatric airway centers from 2015-2026 for clinical characteristics, surgical details, and post-operative outcomes. RESULTS: Forty-nine children met criteria (77.6% male). The median gestational age was 25.7 weeks [24, 26.9], birth weight 0.7 kg [0.5, 0.8], and corrected gestational age at operation 4.4 months [2.3, 10.2]. Most had grade 3 BPD (79.6%). The primary surgical indications included severe respiratory events (n=30, 61.2%), chronic high ventilator support (n=6, 12.2%), and positive pressure dependence (n=13, 26.5%). Posterior tracheopexy and bronchopexy was performed in most patients (95.9% and 87.8%). There were no major surgical complications or procedure-related mortalities. The median follow-up was 1.7 years [0.2, 3.8]. The median PEEP decreased from 11 cmH2O [9, 15] pre-operatively to 7 cmH2O [0, 9] at 3 months, p<0.001. The majority of patients with severe pre-operative respiratory events no longer experienced these events post-operatively (63.3%). Among patients without a tracheostomy pre-operatively, a group in whom tracheostomy might otherwise be expected, only 21.7% required one. Conversely, 19.4% of those who had a tracheostomy were decannulated by the end of follow-up. CONCLUSIONS: Tracheopexy in a highly selected cohort of children with BPD and severe TBM was safe, associated with weaning of respiratory support, and decreased frequency of severe respiratory events.