Aortopexy - Indications, Procedure, and Complications

What Is Aortopexy?

Aortopexy is a surgical procedure to correct a congenital (present from birth) condition called tracheal deviation. The tracheal deviation is a condition in which the trachea (windpipe) is displaced or deviated to one side, which can cause breathing difficulties and other complications. It is typically performed in children or young adults with a condition known as tracheobronchomalacia (collapse of the airways making it difficult to breathe). Aortopexy involves the surgical fixation of the trachea to the spine or the aorta, which provides support and helps prevent collapse.

What Are the Indications of the Aortopexy Procedure?

Some of the indications for aortopexy include:

• Tracheal Stenosis: Narrowing of the trachea, which can occur due to injury, congenital disabilities, or disease, can cause difficulty breathing and be treated with aortopexy.

• Tracheomalacia: A condition where the trachea is flaccid and collapses, causing breathing difficulties.

• Tracheal Diverticulum: A pouch that forms in the trachea, which can cause airway obstruction and other problems.

• Vascular Rings: Rings of blood vessels around the trachea can cause difficulty breathing, wheezing, and coughing.

• Tracheoesophageal Fistula (TEF): An abnormal connection between the trachea and the esophagus can lead to aspiration, coughing, and other problems.

• Congenital Tracheal Anomalies: Children born with malformations of the trachea, including tracheal stenosis (trachea is constricted and resists the ability to breathe normally), tracheomalacia (walls of the trachea are not rigid), or tracheoesophageal fistula (the connection between esophagus and trachea).

A multidisciplinary team typically decides to perform an aortopexy procedure that consists of specialists, including pediatric surgeons, pulmonologists, and otolaryngologists, who will take into account the specific case, the severity of the symptoms, and other relevant factors.

How Is the Aortopexy Procedure Performed?

• Aortopexy is a surgical procedure performed to reposition the aortic arch in cases where it has abnormally migrated to the right side of the chest, causing compression on the airway and trachea. A slit in the neck is made during the process, detaching the aortic arch from its usual position. The aortic arch is then rotated and fixed back in a more anatomically correct position to relieve pressure on the trachea and airway.

• The first step is to make a slit in the neck during the process, separating the sternocleidomastoid muscle to expose the aortic arch. The aortic arch is then carefully dissected and freed from its surrounding structures, including the esophagus, carotid artery, and vagus nerve.

• Next, the aortic arch is rotated into its new position and secured using sutures attached to the first rib. This rotation typically involves turning the aortic arch counter-clockwise so that it lies in a more anatomically correct position in the chest.

• Once the aortic arch is properly positioned, the surrounding tissues and muscles are carefully sutured back together, and the incision is closed. The patient is then placed in a neck brace or collar to help protect the surgical site and maintain proper positioning during the healing process.

• Aortopexy is typically performed under general anesthesia, meaning the patient is asleep during the surgery. The procedure takes about two to four hours to complete. Patients typically stay in the hospital for two to four days following the procedure to ensure proper healing and monitoring of any complications.

• Complications of aortopexy can include bleeding, infection, nerve injury, and problems with wound healing. However, these complications are relatively rare, and most patients experience significant improvement in their symptoms and quality of life following the procedure.

What Are the Complications Associated With Aortopexy?

Although aortopexy is considered a safe and effective treatment option, it is still a major surgical procedure and carries certain risks and complications.

Some of the most common risks associated with aortopexy include the following:

• Anesthesia Risks: As with any surgical procedure, there are risks associated with anesthesia, including reactions to the drugs, breathing difficulties, and allergic reactions.

• Bleeding: Excessive bleeding during the surgery can lead to serious complications, such as blood loss, transfusion, and even death.

• Infection: The risk of infection is present with any surgical procedure and can lead to serious consequences, including fever, sepsis, and wound breakdown.

• Airway Complications: There is a risk of airway complications during and after the surgery, including difficulty breathing, stridor (high-pitched noise while breathing), and tracheal stenosis (narrowing the trachea).

• Recurrent Tracheal Collapse: Although aortopexy is considered a highly effective treatment option, there is still a risk of recurrent tracheal collapse, which may require repeat surgical intervention.

• Nerve Injury: There is a risk of nerve injury during the surgery, which can lead to weakness or loss of sensation in the affected area.

• Cardiopulmonary Complications: Complications related to the heart and lungs, such as arrhythmia, respiratory failure, and pneumonia, can occur during or after the surgery.

It is important to note that these risks are rare, and most patients who undergo aortopexy experience no serious complications.

What Is the Recovery Time of Aortopexy Surgery?

• Aortopexy is a surgical procedure used to correct a condition known as tracheomalacia, where the trachea (windpipe) collapses easily. The recovery time after an aortopexy procedure varies based on several factors, including the patient's age, overall health, and the extent of the procedure.

• Typically, patients can return to normal activities within four to six weeks but may need to avoid strenuous exercise or heavy lifting for several weeks after surgery. Pain and discomfort are usually managed with pain medication prescribed by the doctor. It is important to follow the surgeon's instructions regarding postoperative care, such as avoiding coughing or straining, to ensure proper healing.

• Most patients experience improvement in breathing immediately after the procedure, but it may take several months for the trachea to heal fully. The success rate of aortopexy is high, but it is important to be aware of any potential complications and to seek medical attention if any issues arise.

Conclusion:

Aortopexy is a relatively straightforward and effective surgical procedure for repositioning the aortic arch and relieving pressure on the trachea and airway. The procedure is typically performed under general anesthesia, and patients experience significant improvement in their symptoms following the procedure. However, as with any surgery, there is always a risk of complications, and patients should discuss these risks with their healthcare provider before deciding to undergo aortopexy.