Further experience with polydioxanone airway stents in children.
Abstract
Introduction The aims of this study were to update our
experience with biodegradable polydioxanone (PDO) airway stents in
children focusing on effectiveness and safety, and to analyse the
factors involved in the different outcomes observed. Materials
and methods Retrospective study of patients managed with PDO stents
from 2012 to 2023. Variables collected: demographics, comorbidities,
indication , clinical baseline, stent size, location, complications,
clinical outcome, and time of follow-up. Statistical analyses were
performed in order to detect the eventual contribution of variables in
the different outcomes observed. Results 54 PDO stents were
placed in 26 patients (median age, 4 m). All showed severe symptoms of
central airway obstruction due to: tracheomalacia 9 patients,
bronchomalacia 5, tracheobronchomalacia 10, and tracheal stenosis 2.
Stent placement was uneventful in every case: 29 stents in the trachea
and 25 in main bronchi. 53,8% of patients needed successive stenting
and all exhibited comorbidities. Complete clinical resolution was
observed in 8 cases (30.7%), partial improvement in 13 (50%),
unchanged in 4 (15.3%), and worsen in one. Age had a significant
positive impact in outcome (6 months vs 3 m.; p=0.024). Additionally,
smaller stents were associated with a better outcome (20 vs 26 mm;
p=0.044). Granulation tissue was the most frequent complication
(34.6%). Five patients (19.2%) died due to severe comorbidities,
follow-up was complete in survivors (median, 58 m). Conclusions
PDO stents are safe and effective when dealing with severe
tracheobronchial obstruction. Stent-related granulation tissue continues
to be a relevant matter of concern. This issue together with increased
degradation times deserve further research.