aortopexy

An aortopexy is a surgical procedure designed to relieve upper airway obstruction caused by external compression of the trachea, most often in infants with tracheomalacia related to vascular structures. By suspending the aorta anteriorly, the procedure moves the aorta away from the trachea and reduces dynamic airway collapse during breathing.

Indications for aortopexy typically include severe or life-threatening tracheomalacia with evidence of tracheal compression from a vascular ring or anomalous aortic arch, often in cases where medical management has failed or where airway obstruction is persistent despite supportive care. It is commonly employed in infants but may be considered in older children with persistent symptoms.

Technique and approach usually involve a left thoracotomy or a thoracoscopic approach to access the aorta. After mobilizing a segment of the aorta, surgeons place nonabsorbable sutures to fix the aorta to the posterior surface of the sternum or to the posterior pericardium/vertebral region, effectively pulling the aorta forward to relieve tracheal compression. The goal is to reduce the external posterior compression on the trachea and thereby improve airway patency.

Outcomes vary, but many patients experience improvement in respiratory symptoms and reduced need for airway interventions. Some may require additional procedures or experience incomplete relief, and long-term results depend on the underlying anatomy and growth. Potential risks include bleeding, infection, injury to nearby structures such as the recurrent laryngeal nerve or esophagus, residual tracheomalacia, and recurrence of symptoms. Alternatives include definitive repair of the vascular ring or other airway-supportive therapies.