Tracheobronchoplasty for severe tracheobronchomalacia

A prospective outcome analysis

Adnan Majid, Jorge Guerrero, Sidhu Gangadharan, David Feller-Kopman, Phillip Boiselle, Malcolm DeCamp, Simon Ashiku, Gaetane Michaud, Felix Herth, Armin Ernst*

*Corresponding author for this work

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)801-807
Number of pages7
JournalChest
Volume134
Issue number4
DOIs
StatePublished - Jan 1 2008

Fingerprint

Tracheobronchomalacia
Polypropylenes
Quality of Life
Dyspnea
Stents
Tracheobronchomegaly

Keywords

  • Central airway obstruction
  • Excessive dynamic airway collapse
  • Obstructive lung disease
  • Outcome
  • Tracheobronchomalacia
  • Tracheobronchoplasty

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Majid, A., Guerrero, J., Gangadharan, S., Feller-Kopman, D., Boiselle, P., DeCamp, M., ... Ernst, A. (2008). Tracheobronchoplasty for severe tracheobronchomalacia: A prospective outcome analysis. Chest, 134(4), 801-807. https://doi.org/10.1378/chest.08-0728
Majid, Adnan ; Guerrero, Jorge ; Gangadharan, Sidhu ; Feller-Kopman, David ; Boiselle, Phillip ; DeCamp, Malcolm ; Ashiku, Simon ; Michaud, Gaetane ; Herth, Felix ; Ernst, Armin. / Tracheobronchoplasty for severe tracheobronchomalacia : A prospective outcome analysis. In: Chest. 2008 ; Vol. 134, No. 4. pp. 801-807.
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abstract = "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.",
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Majid, A, Guerrero, J, Gangadharan, S, Feller-Kopman, D, Boiselle, P, DeCamp, M, Ashiku, S, Michaud, G, Herth, F & Ernst, A 2008, 'Tracheobronchoplasty for severe tracheobronchomalacia: A prospective outcome analysis', Chest, vol. 134, no. 4, pp. 801-807. https://doi.org/10.1378/chest.08-0728

Tracheobronchoplasty for severe tracheobronchomalacia : A prospective outcome analysis. / Majid, Adnan; Guerrero, Jorge; Gangadharan, Sidhu; Feller-Kopman, David; Boiselle, Phillip; DeCamp, Malcolm; Ashiku, Simon; Michaud, Gaetane; Herth, Felix; Ernst, Armin.

In: Chest, Vol. 134, No. 4, 01.01.2008, p. 801-807.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Tracheobronchoplasty for severe tracheobronchomalacia

T2 - A prospective outcome analysis

AU - Majid, Adnan

AU - Guerrero, Jorge

AU - Gangadharan, Sidhu

AU - Feller-Kopman, David

AU - Boiselle, Phillip

AU - DeCamp, Malcolm

AU - Ashiku, Simon

AU - Michaud, Gaetane

AU - Herth, Felix

AU - Ernst, Armin

PY - 2008/1/1

Y1 - 2008/1/1

N2 - 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.

AB - 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.

KW - Central airway obstruction

KW - Excessive dynamic airway collapse

KW - Obstructive lung disease

KW - Outcome

KW - Tracheobronchomalacia

KW - Tracheobronchoplasty

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Majid A, Guerrero J, Gangadharan S, Feller-Kopman D, Boiselle P, DeCamp M et al. Tracheobronchoplasty for severe tracheobronchomalacia: A prospective outcome analysis. Chest. 2008 Jan 1;134(4):801-807. https://doi.org/10.1378/chest.08-0728