The standard treatment of innominate artery compression of the trachea has been innominate artery suspension, but the syndrome can recur when this technique is used. From October 1985 until March 1991, 29 infants and children were treated for this syndrome by innominate artery reimplantation. In all patients severe anterior vascular compression of the trachea was demonstrated preoperatively by bronchoscopy and in 17 the diagnosis was confirmed by magnetic resonance imaging scanning. Indications for operation included apneic episodes in 17 (58.6%), severe stridor in seven (24.1%), recurrent bronchopulmonary infections in four (13.8%), and exercise-induced stridor in one (3.4%). Through a median sternotomy, the innominate artery was reimplanted more proximally on the ascending aorta and to the right of the trachea. In this new position, the innominate artery no longer crosses the trachea anteriorly, and the anatomic cause of tracheal obstruction is completely eliminated. There were no early or late deaths, and 27 of the 29 patients (93%) had complete resolution of symptoms. Partial resolution of symptoms was seen in two patients (7%). Reimplantation of the innominate artery offers a unique method by which the anatomic cause of tracheal compression is eliminated. It is a safe and effective means of treating symptomatic compression of the trachea by the innominate artery.