Tracheobronchoplasty for severe tracheobronchomalacia: a prospective outcome analysis.
BACKGROUND
Central airway stabilization with silicone stents can improve respiratory symptoms in patients with severe symptomatic tracheobronchomalacia (TBM) but is associated with a relatively high rate of complications. Surgery with posterior tracheobronchial splinting using a polypropylene mesh has also been used for this condition but to date has not been evaluated prospectively and objectively for patient outcomes.


OBJECTIVE
To evaluate the effect of surgical tracheobronchoplasty on symptoms, functional status, quality of life, lung function, and exercise capacity in patients with severe and symptomatic TBM.


METHODS
A prospective observational study in which baseline measurements were compared to those obtained 3 months after surgical tracheobronchoplasty.


RESULTS
Of 104 referred patients to our complex airway center for severe TBM, 77 had baseline measurements. Of this group, 57 patients had severe malacia and underwent stent placement for central airway stabilization. Of those, 37 patients reported improvement in respiratory symptoms and 35 were considered for surgical tracheobronchoplasty. Two patients were excluded from surgery for medical reasons. Median age was 61 years (range, 39 to 83 years), 20 patients were men, 11 patients (31%) had COPD, 9 patients (26%) had asthma, and 4 patients (11%) had Mounier-Kuhn syndrome. Thirty-three patients (94%) presented with severe dyspnea, 26 patients (74%) with uncontrollable cough, and 18 patients (51%) reported recurrent pulmonary infections. Two patients (3%) presented with respiratory failure requiring mechanical ventilation. After surgery, quality of life scores improved in 25 of 31 patients (p < 0.0001), dyspnea scores improved in 19 of 26 patients (p = 0.007), functional status scores improved in 20 of 31 patients (p = 0.003), and mean exercise capacity improved in 10 patients (p = 0.012).


CONCLUSIONS
In experienced hands, surgical central airway stabilization with posterior tracheobronchial splinting using a polypropylene mesh improves respiratory symptoms, health-related quality of life, and functional status in highly selected patients with severe symptomatic TBM.
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Adnan
A
Majid
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Jorge
J
Guerrero
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Sidhu
S
Gangadharan
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
David
D
Feller-Kopman
Center for Airway Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Phillip
P
Boiselle
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Malcolm
M
DeCamp
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Simon
S
Ashiku
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Gaetane
G
Michaud
Division of Pulmonary and Interdisciplinary Endoscopy, Thoraxklinik, Heidelberg, Germany.
Felix
F
Herth
Division of Cardiothoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: aernst@bidmc.harvard.edu.
Armin
A
Ernst
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001982:Bronchial Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes; D011446:Prospective Studies; D019919:Prosthesis Implantation; D011788:Quality of Life; D013526:Surgical Mesh; D014133:Tracheal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
D011126:Polypropylenes