Comparison of expiratory CT airway abnormalities before and after tracheoplasty surgery for tracheobronchomalacia

OBJECTIVES: The purpose of this study is to assess the prevalence and severity of expiratory multidetector computer tomography airway abnormalities, including central airway collapse and peripheral air trapping, before and after tracheoplasty, a novel surgical treatment for tracheomalacia. MATERIALS AND METHODS: Our hospital information system retrospectively identified all patients with bronchoscopically diagnosed tracheobronchomalacia referred for computer tomography airway imaging pretracheoplasty and posttracheoplasty during a 41-month period. All patients underwent a standard multidetector computer tomography protocol comprised of imaging both at end inspiration and dynamic expiration. Two observers simultaneously reviewed the images. Maximal expiratory tracheal collapse and total air-trapping scores were calculated pretracheoplasty and posttracheoplasty for each patient. Statistical analysis was performed using the paired t test and Wilcoxon signed-ranks test. RESULTS: The study cohort was comprised of 16 patients, 12 men and 4 women, with mean age of 60 years (range: 41 to 80). Mean percentage expiratory tracheal collapse pretracheoplasty was 70%±28 compared with 36%±27 posttracheoplasty (P<0.0001). Fifteen (94%) of sixteen patients demonstrated air trapping both pretracheoplasty and posttracheoplasty. Median total air-trapping scores were similar between preoperative (median 6, range: 0 to 9) and postoperative (median 6, range: 0 to 10) scans (P=0.43). All patients experienced symptomatic improvement after surgery. CONCLUSIONS: Tracheoplasty is associated with a significant reduction in expiratory tracheal collapse and subjective symptomatic improvement, but it does not change the severity of air trapping.