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TRACHEOBRONCHOPLASTY FOR SEVERE TRACHEOBRONCHOMALACIA: A PROSPECTIVE OUTCOME ANALYSIS

Beth Israel Deaconess Medical Center, Boston, MA

PURPOSE: To evaluate the effect of surgical tracheobronchoplasty on symptoms, functional status, quality of life, lung function and exercise capacity in patients with symptomatic and severe tracheobronchomalacia(TBM) .

METHODS: Single center , prospective observational study from July 2004 to March 2007, in patients who were referred to our Complex Airway Center for evaluation of respiratory symptoms caused by TBM. Patients underwent baseline measurements(functional bronchoscopy, airway CT, spirometry (FEV1), 6-minute walk test, dyspnea scores (baseline dyspnea index, ATS dyspnea score), performance status (Karnofsky performance scale) and quality of life questionnaires (St. George's Respiratory Questionnaire). Patients underwent a silicone stent trial for 10-14 days. If their symptoms improved, stents were removed and appropiate patients underwent surgical tracheobronchoplasty. Tracheobronchoplasty was performed through a right postero-lateral thoracotomy with plication of the posterior membranous wall using a Marlex mesh. Patients were followed 3 months after surgery and measurements were repeated.

RESULTS: Total number of patients referred 73, 55 had airway stenting and 44 of these had surgery. Baseline and 3 month follow up data is available for 25 patients (Table 1). Demographics: Gender (M=15 / F=10) / Median age 62 years (40-81); Co-Morbidities: COPD (n=9), Asthma (n=8), Prior intubation (n=2), GERD (n=10), Mounier-Kuhn syndrome (n=4), bronchiectasis (n=1). Presenting symptoms: severe dyspnea (n=26), uncontrollable cough (n=21), recurrrent respiratory infections (n=13) and respiratory failure (n=2). Post-operative complications occurred in 11 patients (39%) (Table 2). Two patients died, one from a massive PE and the other from a UIP Flare. LOS: Mean +/- SD: 13 +/- 16 Median 8 (3-90).

CONCLUSION: Airway stabilization in patients with severe TBM by surgical plication using a Marlex Mesh, can improve respiratory symptoms, quality of life, functional status and six minute walk test. In carefully selected patients, even with significant co-morbidities, tracheobronchoplasty can be performed with acceptable morbidity and mortality.

CLINICAL IMPLICATIONS: In selected patients with severe and symptomatic TBM, surgical airway stabilization in experienced hands may relieve symptoms and improve quality of life.

DISCLOSURE: Adnan Majid, No Financial Disclosure Information; No Product/Research Disclosure Information