Long segment malacia of the trachea or main stem bronchi in children is not always suitable for surgical correction; patients may therefore remain
ventilator-dependent and/or experience severe obstructive crises. We treated 7 children (ages, 4 months to 9 years) with extreme structural central
airway obstruction with
stent implantations. Six were mechanically ventilated; 5 had frequent life-threatening obstructive spells requiring
deep sedation or
paralysis. Diagnoses were: syndrome-associated
tracheobronchomalacia (n = 4),
malignancy infiltrating the carina (n = 1),
congenital tracheal stenosis (n = 1), and tracheobronchial compression by a malpositioned aorta (n = 1). Six tracheal and 13 bronchial
stents were endoscopically placed. The
prostheses included mesh titan (n = 5), the newer
shape memory material nitinol (n = 13), and 1 Y-shaped carina
stent. Follow-up was reported for 7 weeks to 72 months. All patients showed marked improvement of their respiratory obstruction. Six children were weaned at least temporarily from ventilation. No significant
bleeding,
stenosis, or perforation was observed. Seven
stents were changed after up to 14 months. Three children are well and at home. In 2 children airway stabilization was successful, but they later died from causes unrelated to
stent placement, and 2 children died due to generalized airway disease. Soft
metal mesh airway
stents can offer a therapeutic option in life-threatening inoperable obstruction of the trachea and main stem bronchi in children.