The aim of this paper is to evaluate and discuss the literature relating to indications, surgical details and clinical results of aortopexy, usually performed for tracheomalacia (TM).
TM is a localized or generalized weakness of the tracheal wall which creates airway obstruction resulting in different degrees of symptoms. It can be isolated or associated with other anomalies such as anterior vascular compression, oesophageal atresia (OA) with tracheo-oesophageal fistula (TOF) or gastro-oesophageal reflux (GOR). Although, in some cases, spontaneous improvement can occur, TM can also result in severe cough, respiratory distress episodes or “near-death” spells (acute life-threatening events, ALTE). Amongst several possible treatments, including tracheostomy and non invasive ventilation, airway stenting, and surgical approaches, aortopexy is a favoured option in many centres. As the anterior tracheal wall is attached through pre-tracheal fascia to the posterior aortic wall, the tracheal lumen is opened by aortopexy.
Despite this popularity, there is a surprising lack of evidence to support aortopexy as effective treatment for TM, and no randomized controlled trials have been published on this subject. Most papers report only small, single centre series.
Moreover, the term ‘aortopexy’ is rather generic and may describe many different approaches and different techniques. The approach to the aorta can be anterior, through a median full or limited sternotomy, possibly associated with cervical incision, lateral or anterolateral, from both sides of the thorax. More recently, thoracoscopic aortopexy has been described.
Materials and methods
A literature review was conducted on PubMed, using the search term “Aortopexy” without setting any temporal or other limits. Continue reading “Aortopexy means lifting anteriorly the aorta and suturing it to the posterior surface of the sternum”