Direct tracheobronchopexy to correct airway collapse due to severe tracheobronchomalacia: Short-term outcomes in a series of 20 patients

Bairdain, Sigrid; Smithers, C. Jason; Hamilton, Thomas E.; Zurakowski, David; Rhein, Lawrence; Foker, John E.; Baird, Christopher W.; Jennings, Russell W.

doi:10.1016/j.jpedsurg.2015.03.016

Cited by 64 publications

(66 citation statements)

References 19 publications

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“…Current therapies for severe tracheobronchomalacia include tracheostomy with prolonged mechanical ventilation, aortopexy, tracheobronchopexy, and intraluminal metallic, silicone, or bioresorbable stents. However, these options carry a significant risk of morbidity and mortality, variable efficacy, and a subset of children still suffer acute life‐threatening events despite these interventions.…”

Section: Introductionmentioning

confidence: 99%

3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

et al. 2019

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Objective To report the clinical safety and efficacy of 3D-printed, patient-specific, bioresorbable airway splints in a cohort of critically ill children with severe tracheobronchomalacia. Methods From 2012–2018, 15 subjects received 29 splints on their trachea, right and/or left mainstem bronchi. The median age at implantation was eight months (range, 3–25 months). Nine children were female. Five subjects had a history of ECMO (extra-corporeal membrane oxygenation), and eleven required continuous sedation, six of which required paralytics to maintain adequate ventilation. Thirteen were chronically hospitalized, unable to be discharged, and seven were hospitalized their entire lives. At the time of splint implantation, one subject required ECMO, one required positive airway pressure, and 13 subjects were tracheostomy and ventilator dependent, requiring a median positive end-expiratory pressure (PEEP) of 14 cmH2O (range, 6–20 cmH20). Outcomes collected included level of respiratory support, disposition, and splint-related complications. Results At the time of discharge from our institution, at a median of 28 days’ post-implantation (range, 10–56 days), the subject on ECMO was weaned from extracorporeal support, and the subjects who were ventilated via tracheostomy had a median change in PEEP (discharge – baseline) of −2.5 cmH2O (range, −15 to 2 cmH2O, p=0.022). At median follow-up of 8.5 months (range, 0.3–77 months), all but one of the 12 surviving subjects lives at home. Of the 11 survivors who were tracheostomy dependent pre-op, one is decannulated, one uses a speaking valve, six use a ventilator exclusively at night, and three remain ventilator dependent. Conclusion This case series demonstrates the initial clinical efficacy of the 3D-printed bioresorbable airway splint device in a cohort of critically ill children with severe tracheobronchomalacia.

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Section: Introductionmentioning

confidence: 99%

3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

et al. 2019

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“…Excessive airway collapse leads to ineffective ventilation and poor clearance of secretions, resulting in a wide spectrum of respiratory symptoms that can progress to bronchiectasis, and in the most severe cases, blue spells and apparent life-threatening events (ALTEs). Currently, there is little consensus on the evaluation, diagnosis, and treatment of severe tracheomalacia, including grading of symptom severity, criteria for radiographic or endoscopic evaluation, medical treatment, and surgical approach (3)(4)(5). According to the 2012 Cochrane review, there is no evidence to support any one therapy over another for the treatment of tracheomalacia (6).…”

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confidence: 99%

“…Surgical options for the treatment of tracheomalacia include pexy procedures (aortopexy, anterior and/or posterior tracheopexy), internal tracheal stents, and external stabilization (3)(4)(5). Aortopexy is the most commonly used technique and addresses anterior vascular compression by indirectly elevating the anterior wall of the trachea.…”

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confidence: 99%

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Three-dimensional printing of external airway splints for tracheomalacia

Shieh¹,

Jennings²

2017

J. Thorac. Dis.

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“…There are several established techniques including tracheobronchopexy, aortopexy, and external stabilization. Direct tracheobronchopexy could be performed via thoracoscopy or thoracotomy for pediatric malacia and is achieved with either anterior suspension and/or posterior fixation (9). For posterior fixation, sutures are passed through the posterior membrane and secured to anterior spinal ligament.…”

mentioning

confidence: 99%