Tracheoplasty for expiratory collapse of central airways.
BACKGROUND
Severe central airway obstruction due to expiratory collapse occurs with malacia of intrathoracic trachea and main bronchi, often with chronic obstructive pulmonary disease. Bronchoscopically observed, it is confirmed by inspiratory-expiratory computerized tomographic chest scans. Prior attempts at surgical stabilization have not given dependable results.


METHODS
Posterior tracheobronchial splinting with polypropylene mesh (Marlex) holds cartilages in more normal configuration, and fixes redundant membranous walls. Fourteen consecutive patients were so treated for severe dyspnea. Prior trials of various autologous and exogenous splints failed.


RESULTS
All felt subjectively improved early, with decreased dyspnea, cough, and secretion retention, and with increased activities. Mean forced expiratory volume in 1 second rose from 51% predicted to 73% (p = 0.009), and peak expiratory flow rate from 49% to 70% (p < 0.00001). One patient was lost to follow-up (1 year), 1 died of unrelated cause (5 years), 1 died of chronic obstructive pulmonary disease (3 years), and 1 had decreased respiratory function over 5 years. Ten patients were available for long-term follow-up: 6 were judged to have an excellent result, 2 were good, and 2 were poor due to collapse of unsplinted main bronchi.


CONCLUSIONS
Complete splinting of all malacic central airways with Marlex restores anatomic configuration and permanently prevents expiratory collapse, with relief of extreme dyspnea, cough, and secretion retention.
General Thoracic Surgical Division, Surgical Services, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. wright.cameron@mgh.harvard.edu
Cameron D
CD
Wright
Hermes C
HC
Grillo
Zane T
ZT
Hammoud
John C
JC
Wain
Henning A
HA
Gaissert
Victor
V
Zaydfudim
Douglas J
DJ
Mathisen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology*; D001672:Biocompatible Materials / Q000627:therapeutic use; D001982:Bronchial Diseases / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000601:surgery*; D014133:Tracheal Diseases / Q000150:complications / Q000601:surgery*
D001672:Biocompatible Materials; D011126:Polypropylenes