0
Original Research: INTERVENTIONAL PULMONOLOGY |

Tracheobronchoplasty for Severe Tracheobronchomalacia: A Prospective Outcome Analysis

Adnan Majid, MD; Jorge Guerrero, MD; Sidhu Gangadharan, MD; David Feller-Kopman, MD, FCCP; Phillip Boiselle, MD, FCCP; Malcolm DeCamp, MD, FCCP; Simon Ashiku, MD; Gaetane Michaud, MD, FCCP; Felix Herth, MD, FCCP; Armin Ernst, MD, FCCP
Author and Funding Information

*From the Division of Cardiothoracic Surgery and Interventional Pulmonology (Drs. Majid, Guerrero, Gangadharan, Feller-Kopman, DeCamp, Ashiku, Michaud, and Ernst) and Center for Airway Imaging (Dr. Boiselle), Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Division of Pulmonary and Interdisciplinary Endoscopy (Dr. Herth), Thoraxklinik, Heidelberg, Germany.

Correspondence to: Armin Ernst, MD, FCCP, Division of Cardiothoracic Surgery and Interventional Pulmonology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Deaconess Building 201, Boston, MA 02215; e-mail: aernst@bidmc.harvard.edu


This work was presented at the CHEST 2007 meeting, where Dr. Majid received the Young Investigator Award.

The authors involved in the development of this article have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(4):801-807. doi:10.1378/chest.08-0728
Text Size: A A A
Published online

Rationale:  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.

Objectives:  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.

Measurements and main 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.

Trial registration:  Clinicaltrials.gov Identifier: NCT00550602

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543