Technical Aspects and Outcomes of Tracheobronchoplasty for Severe Tracheobronchomalacia

Current concepts in severe adult tracheobronchomalacia: evaluation and treatment

“…If found, these diagnoses require adequate treatment prior to surgical evaluation. Previous observations from our group have revealed that GERD seems more prevalent in patients with TBM as compared with the general population and it may negatively impact the outcome of surgical tracheobronchoplasty (25,26). However, follow up studies are warranted to fully corroborate this correlation and thus, optimize the evaluation approach for patients with diffuse TBM.…”

“…The suture placement is also carefully selected to achieve tension across the membranous wall. The operation has historical roots going back over 50 years (16,29) and the BIDMC technique has been described in detail elsewhere (25). It is worth noting that concentric forms of ECAC do not respond to this posterior stabilization.…”

“…Despite these limitations, a planned shortterm (<2 weeks) stent trial still may yield useful information about those patients with diagnosed TBM who may respond best to surgery. In our experience, between 60% and 75% of patients with TBM will respond to the stent trial in positive fashion, and improvement in symptoms, quality of life and exercise capacity following definitive surgical airway stabilization with tracheobronchoplasty is seen in 80% of these selected patients (21,25).…”

“…There were no reoperations for bleeding. Aspiration bronchoscopy was used frequently in the postoperative period (16,25,30).…”

Personalized interventions for tracheobronchomalacia

“…In one study of 63 patients, however, complications were not uncommon and included a new respiratory infection in 14 patients, pulmonary embolism in two, and atrial fibrillation in six; an additional six patients required reintubation, and nine received a postoperative tracheotomy; 47 patients required postoperative bronchoscopy for aspiration of secretions. Two patients (3.2%) died postoperatively-one due to worsening usual interstitial pneumonia and the other of massive pulmonary embolism (16). Because of the morbidity and mortality described in previous attempts for external stabilization for TM, searching for safer alternatives is warranted.…”