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 analyze 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 to detect the eventual contribution of variables in the different outcomes observed.

Results: Fifty-four PDO stents were placed in 26 patients (median age, 4 months). All showed severe symptoms of central airway obstruction due to tracheomalacia in nine patients, bronchomalacia five, tracheobronchomalacia 10, and tracheal stenosis two. Stent placement was uneventful in every case: 29 stents in the trachea and 25 in the main bronchi. 53.8% of patients needed successive stenting, and all exhibited comorbidities. Complete clinical resolution was observed in eight cases (30.7%), partial improvement in 13 (50%), unchanged in 4 (15.3%), and worsened in one. Age had a significant positive impact on outcome (6 vs. 3 months; 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 months).

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, deserves further research.

Keywords: airway; biodegradable stent; bronchoscopy; children; tracheomalacia.