Purpose <p>Tracheomalacia is characterised by dynamic tracheal collapse causing airway obstruction, particularly during expiration. In severe cases, surgical intervention with aortopexy may be required. This study reports long-term outcomes following suprasternal aortopexy, exploring predictors of operative success/failure.</p> Methods <p>All patients undergoing aortopexy between February 2016 and May 2019 were included. Electronic patient records were reviewed for demographics, associated conditions, preoperative symptoms, dynamic flexible bronchoscopy findings and postoperative outcomes. Outcomes were categorised by degree of symptom improvement or resolution.</p> Results <p>Twenty-eight patients (22 male, 78%) underwent aortopexy at a median age of 8 months (range 19 days–5 years 9 months) with follow-up of 6 years 7 months (range 5 years 2 months–8 years 9 months). Patients were stratified into oesophageal atresia/tracheoesophageal fistula, prematurity, syndromic and primary tracheomalacia groups. Short-term improvement occurred in 75%, with complete resolution in 46%. At long-term review, 82% improved and 64% were symptom-free. Respiratory infection was the most common persistent symptom. Syndromic patients had the poorest outcomes and no later improvement.</p> Conclusions <p>Suprasternal aortopexy is a safe and durable treatment for tracheomalacia. While most patients improve early, further improvement may occur over time. Caution is warranted when considering aortopexy in children with underlying systemic syndromes.</p>