Rorris Filippos-Paschalis, Chatzimichali Evangelia, Liverakou Evangelia, Antonopoulos Constantine N, Balis Evangelos, Kotsifas Constantinos, Stratakos Grigoris, Koutsoukou Antonia, Zisis Charalampos
Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece.
Department of Vascular Surgery, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
JTCVS Tech. 2023 Apr;18:157-163. doi: 10.1016/j.xjtc.2023.01.006. Epub 2023 Jan 18.
A remarkable increase in the number of patients presenting with tracheal complications after prolonged endotracheal intubation and mechanical ventilation for the management of the severe COVID-19-associated respiratory failure has been observed. In this study, we assessed the postoperative outcomes of tracheal resection in patients with COVID-19.
We conducted a retrospective study in which all patients with a history of prolonged invasive mechanical ventilation due to COVID-19 infection, who were treated with tracheal resection and reconstruction, were included. The primary objective was in-hospital mortality and postoperative reintervention rate. The secondary objective was the time to tracheal restenosis.
During the 16-month study period, 11 patients with COVID-19 with tracheal complications underwent tracheal resection with end-to-end anastomosis. Mean patient age was 51.5 ± 9 years, and the majority were male (9 patients). Eight patients were referred for management of postintubation tracheal stenosis, and 3 patients were referred for tracheoesophageal fistula. Eight patients had a history of tracheostomy during the COVID-19 infection hospitalization. There was 1 in-hospital death (9.1%) due to septicemia in the intensive care unit approximately 2 months after the operation. Postoperatively, 32 reinterventions were required for tracheal restenosis due to granulation tissue formation. The risk for reintervention was higher during the first 3 months after the index operation. Four patients developed tracheal restenosis (36.4%), and 2 of them required endotracheal stent placement during the follow-up period.
Tracheal resection and reconstruction after COVID-19 infection are associated with a high reintervention rate postoperatively. Such patients require close follow-up in expert interventional pulmonology units, and physicians should be on high alert for the early diagnosis and optimal management of tracheal restenosis.
观察到在因严重新型冠状病毒肺炎（COVID-19）相关呼吸衰竭而进行长时间气管插管和机械通气后，出现气管并发症的患者数量显著增加。在本研究中，我们评估了COVID-19患者气管切除术后的结局。
我们进行了一项回顾性研究，纳入了所有因COVID-19感染而有长时间有创机械通气史且接受气管切除和重建治疗的患者。主要目标是住院死亡率和术后再次干预率。次要目标是气管再狭窄的时间。
在16个月的研究期间，11例有气管并发症的COVID-19患者接受了端端吻合的气管切除术。患者平均年龄为51.5±9岁，大多数为男性（9例）。8例因插管后气管狭窄转诊，3例因气管食管瘘转诊。8例患者在COVID-19感染住院期间有气管切开史。术后约2个月，1例患者在重症监护病房因败血症死亡（9.1%）。术后，由于肉芽组织形成，32次因气管再狭窄需要再次干预。首次手术后的前3个月再次干预的风险更高。4例患者出现气管再狭窄（36.4%），其中2例在随访期间需要放置气管内支架。
COVID-19感染后的气管切除和重建与术后高再次干预率相关。此类患者需要在专业介入肺病科进行密切随访，医生应高度警惕气管再狭窄的早期诊断和最佳管理。
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