Tracheobronchopexy to Avoid Tracheostomy in Esophageal Atresia Patients With Severe Life-Threatening Tracheobronchomalacia

Infographic · Jun 2025 · 1 min read

In brief

Study of 80 esophageal atresia patients demonstrates that tracheobronchopexy effectively treats severe life-threatening tracheobronchomalacia, eliminating blue spells/BRUEs and enabling 94% to avoid tracheostomy. Median 39-month follow-up shows sustained reduction in ventilator dependence with 5% mortality related primarily to comorbidities.

Tracheobronchopexy successfully eliminated blue spells/BRUEs in EA patients with severe TBM and avoided tracheostomy in 94% of cases.
Most EA patients (90%) had complete airway collapse on preoperative bronchoscopy, requiring surgical intervention at median age 6 months.
Posterior approach tracheobronchopexy was most common (73%), with thoracic trachea alone addressed in 58% of cases.
Significant reduction in positive pressure ventilation and ventilator dependence post-operatively (p<0.001) at median 39-month follow-up.
Low mortality (5%) with one 30-day operative death; tracheobronchopexy should be first-line treatment for severe life-threatening TBM in EA.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with surgical technique variations. Bar charts or percentage indicators display outcome metrics below each approach. Color-coded sections distinguish the three treatment methods.

Hester F. Shieh, Russell W. Jennings, Thomas E. Hamilton, ∙ Shawn Izadi, ∙ Benjamin Zendejas, C. Jason Smithers

Background

Esophageal atresia (EA) is associated with tracheobronchomalacia (TBM), which in its most severe form, causes blue spells, brief resolved unexplained events (BRUEs) that can require cardiopulmonary resuscitation (CPR), and positive pressure ventilation (PPV) or ventilator dependence, often requiring tracheostomy. We study the role of tracheobronchopexy, as an alternative to tracheostomy, in EA patients with severe life-threatening TBM.

Methods

We reviewed EA patients who underwent tracheobronchopexy for blue spells, BRUEs, and failure to wean PPV or extubate from February 2013 to September 2021 at two institutions. Patient characteristics, surgical techniques, and respiratory outcomes were reviewed.

Results

80 EA patients (most Gross type C 92.5 %) underwent 91 tracheobronchopexies at median age 6 (IQR 3–14) months for blue spells/BRUEs (53 %), PPV (21 %), and ventilator dependence (26 %). On preoperative dynamic bronchoscopy, most (90 %) demonstrated complete airway collapse. Surgical approach for tracheobronchopexy was posterior (73 %), anterior (23 %), and simultaneous posterior and anterior (4 %). Tracheobronchopexy included thoracic trachea alone (58 %), trachea and bronchi (41 %), and bronchi alone (1 %). At latest follow up of median 39 (IQR 14–64) months, there were no recurrent blue spells/BRUEs (p < 0.001) and significantly reduced PPV and ventilator dependence (p < 0.001). Nearly all patients (n = 75, 94 %) avoided tracheostomy. Mortality was 5 %, one 30-day operative mortality and three long-term mortalities related to underlying comorbidities.

Conclusions

In EA patients with severe life-threatening TBM, tracheobronchopexy significantly reduces blue spells/BRUEs, PPV, and ventilator dependence, and avoids tracheostomy. This surgical strategy should be considered the treatment of choice for EA patients with severe life-threatening TBM symptoms.

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