title: Direct tracheobronchopexy to correct airway collapse due to severe tracheobronchomalacia: Short-term outcomes in a series of 20 patients.
abstract: OBJECTIVE
  Tracheobronchomalacia (TBM) is associated with esophageal atresia, tracheoesophageal fistulas, and congenital heart disease. TBM results in chronic cough, poor mucous clearance, and recurrent pneumonias. Apparent life-threatening events or recurrent pneumonias may require surgery. TBM is commonly treated with an aortopexy, which indirectly elevates trachea's anterior wall. However, malformed tracheal cartilage and posterior tracheal membrane intrusion may limit its effectiveness. This study describes patient outcomes undergoing direct tracheobronchopexy for TBM.
  
  
  METHODS
  The records of patients that underwent direct tracheobronchopexy at our institution from January 2011 to April 2014 were retrospectively reviewed. Primary outcomes included TBM recurrence and resolution of the primary symptoms. Data were analyzed by McNemar's test for matched binary pairs and logistic regression modeling to account for the endoscopic presence of luminal narrowing over multiple time points per patient.
  
  
  RESULTS
  Twenty patients were identified. Preoperative evaluation guided the type of tracheobronchopexy. 30% had isolated anterior and 50% isolated posterior tracheobronchopexies, while 20% had both. Follow-up was 5 months (range, 0.5-38). No patients had postoperative ALTEs, and pneumonias were significantly decreased (p=0.0005). Fewer patients had tracheobronchial collapse at postoperative endoscopic exam in these anatomical regions: middle trachea (p=0.01), lower trachea (p<0.001), and right bronchus (p=0.04).
  
  
  CONCLUSIONS
  The use of direct tracheobronchopexy resulted in ALTE resolution and reduction of recurrent pneumonias in our patients. TBM was also reduced in the middle and lower trachea and right mainstem bronchus. Given the heterogeneity of our population, further studies are needed to ascertain longer-term outcomes and a grading scale for TBM severity.
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Charles Jason
authors.initials: CJ
authors.lastname: Smithers
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Hamilton
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Pulmonology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rhein
authors.affiliation: University of Minnesota, Minneapolis, MA, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Foker
authors.affiliation: Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Baird
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Russell.jennings@childrens.harvard.edu.
authors.forename: Russell W
authors.initials: RW
authors.lastname: Jennings
mesh_terms: D001980:Bronchi / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D055089:Tracheobronchomalacia / Q000601:surgery*; D016896:Treatment Outcome
keywords: Apparent life threatening events (ALTE); Pneumonias; Tracheobronchopexy