Single-Center Experience of Tracheobronchoplasty for Tracheobronchomalacia: Perioperative Outcomes

Abstract

Despite an arduous hospital course with significant risk of severe complication, patients undergoing tracheobronchoplasty for severe tracheobronchomalacia have low risk of mortality and most are discharged directly to home.

Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

“…6 Commonly, airway stents are placed for a short period of time (5 to 10 days) to assess clinical improvement and help identify those patients who may benefit from surgery. 2,3 Subjective and objective evaluation of respiratory symptoms, health-related quality of life (St George's Respiratory Questionnaire and ECAC, THE PULMONARY DECEIVER cough quality of life), lung function (forced expiratory volume), exercise capacity (6minute walk test), and functional status (Karnofsky Performance Scale) using validated scoring scales should be used before and during stenting. 6,23 In a recent case series, 73% of patients (31 of 42) underwent robotic TBP without antecedent stent trial.…”

“…The uncertainties of this condition make identification and investigation challenging. 2,3 Presently there is no consensus definition or nomenclature; this pathology has been addressed with several names, contributing to diagnostic inconsistency. Furthermore, these patients often present with multiple comorbidities, such as chronic obstructive pulmonary disease (COPD), bronchiectasis, asthma, gastroesophageal reflux disease, vocal cord dysfunction, obstructive sleep apnea, and laryngopharyngeal reflux, which manifest with similar symptoms challenging appropriate allocation to an attributable etiology.…”

“…4,[6][7][8] The "E" in ECAC has been described as both expiratory and excessive without consistency. 2,3,9,10 Although this ambiguity may contribute to confusion, both terms describe the same pathologic entity. Excessive dynamic airway collapse refers to an excessive forward displacement of the posterior membranous portion of the tracheal wall due to weakness and atrophy of the longitudinal elastic fibers.…”

Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Medical and Surgical Treatment

“…27 However, TBP is associated with considerable (47%) postoperative morbidity but with a 30-day mortality of 1%. 30 A recent study evaluated intermediate (1.5 years) and long-term (6 years) changes in expiratory tracheal collapsibility by dynamic CT in patients with ECAC following TBP and correlated that with clinical findings. 31 Expiratory tracheal collapsibility significantly decreased on intermediate followup.…”

Frailty Characteristics Predict Respiratory Failure in Patients Undergoing Tracheobronchoplasty

“…Respiratory complications are the leading cause of morbidity in patients undergoing surgical central airway stabilization (tracheobronchoplasty [TBP]) for severe diffuse tracheobronchomalacia (TBM). [1–3] Yet, detailed risk stratification models to predict respiratory complications do not exist, and currently available risk stratification systems, such as the American Society of Anesthesiologists (ASA) or the Society of Thoracic Surgeons Adult Cardiac Surgery risk, do not consider the physiologic characteristics specific to this high-acuity population.…”