Advertisement

Tracheobronchoplasty yields long-term anatomy, function, and quality of life improvement for patients with severe excessive central airway collapse

      Abstract

      Objectives

      This study examines the long-term anatomic and clinical effects of tracheobronchoplasty in severe excessive central airway collapse.

      Methods

      Included patients underwent tracheobronchoplasty for excessive central airway collapse (2002-2016). The cross-sectional area of main airways on dynamic airway computed tomography was measured before and after tracheobronchoplasty. Expiratory collapse was calculated as the difference between inspiratory and expiratory cross-sectional area divided by inspiratory cross-sectional area ×100. The primary outcome was improvement in the percentage of expiratory collapse in years 1, 2, and 5 post-tracheobronchoplasty. Secondary outcomes included mean response profile for the 6-minute walk test, Cough-Specific Quality of Life Questionnaire, Karnofsky Performance Status score, and St George Respiratory Questionnaire. Repeated-measures analysis of variance was used for statistical analyses.

      Results

      The cohort included 61 patients with complete radiological follow-up at years 1, 2, and 5 post-tracheobronchoplasty. A significant linear decrease in the percentage of expiratory collapsibility of the central airways after tracheobronchoplasty was present. Anatomic repair durability was preserved 5 years after tracheobronchoplasty, with decrease in percentage of expiratory airway collapse up to 40% and 30% at years 1 and 2, respectively. The St George Respiratory Questionnaire (74.7 vs 41.8%, P < .001) and Cough-Specific Quality of Life Questionnaire (78 vs 47, P < .001) demonstrated significant improvement at year 5 compared with baseline. Similar results were observed in the 6-minute walk test (1079 vs 1268 ft, P < .001) and Karnofsky score (57 vs 82, P < .001).

      Conclusions

      Tracheobronchoplasty has durable effects on airway anatomy, functional status, and quality of life in carefully selected patients with severe excessive central airway collapse.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      BI (bronchus intermedius), CT (computed tomography), CQLQ (Cough-Specific Quality of Life Questionnaire), ECAC (excessive central airway collapse), IQR (interquartile range), KPS (Karnofsky Performance Status), LMSB (left mainstem bronchus), MCID (minimal clinically important difference), TBM (tracheobronchomalacia), TBP (tracheobronchoplasty), QOL (quality of life), SGRQ (St George Respiratory Questionnaire), 6MWT (6-minute walk test)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Buitrago D.H.
        • Wilson J.L.
        • Parikh M.
        • Majid A.
        • Gangadharan S.P.
        Current concepts in severe adult tracheobronchomalacia: evaluation and treatment.
        J Thorac Dis. 2017; 9: E57-E66
        • Murgu S.
        • Colt H.
        Tracheobronchomalacia and excessive dynamic airway collapse.
        Clin Chest Med. 2013; 34: 527-555
        • Kheir F.
        • Majid A.
        Tracheobronchomalacia and excessive dynamic airway collapse: medical and surgical treatment.
        Semin Respir Crit Care Med. 2018; 39: 667-673
        • Kheir F.
        • Fernandez-Bussy S.
        • Gangadharan S.P.
        • Majid A.
        Excessive dynamic airway collapse or tracheobronchomalacia: does it matter?.
        Arch Bronconeumol. 2019; 55: 69-70
        • Gangadharan S.P.
        • Bakhos C.T.
        • Majid A.
        • Kent M.S.
        • Michaud G.
        • Ernst A.
        • et al.
        Technical aspects and outcomes of tracheobronchoplasty for severe tracheobronchomalacia.
        Ann Thorac Surg. 2011; 91: 1574-1581
        • Bezuidenhout A.F.
        • Boiselle P.M.
        • Heidinger B.H.
        • Alape D.
        • Buitrago D.H.
        • Majid A.
        • et al.
        Longitudinal follow-up of patients with tracheobronchomalacia after undergoing tracheobronchoplasty: computed tomography findings and clinical correlation.
        J Thorac Imaging. 2019; 34: 278-283
        • Lazzaro R.
        • Patton B.
        • Lee P.
        • Karp J.
        • Mihelis E.
        • Vatsia S.
        • et al.
        First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia.
        J Thorac Cardiovasc Surg. 2019; 157: 791-800
        • 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; 134: 801-807
        • Majid A.
        • Gaurav K.
        • Sanchez J.M.
        • Berger R.L.
        • Folch E.
        • Fernandez-Bussy S.
        • et al.
        Evaluation of tracheobronchomalacia by dynamic flexible bronchoscopy. A pilot study.
        Ann Am Thorac Soc. 2014; 11: 951-955
        • Majid A.
        • Alape D.
        • Kheir F.
        • Folch E.
        • Ochoa S.
        • Folch A.
        • et al.
        Short-term use of uncovered self-expanding metallic airway stents for severe expiratory central airway collapse.
        Respiration. 2016; 92: 389-396
        • Boiselle P.M.
        • Feller-Kopman D.
        • Ashiku S.
        • Weeks D.
        • Ernst A.
        Tracheobronchomalacia: evolving role of dynamic multislice helical CT.
        Radiol Clin North Am. 2003; 41: 627-636
        • Boiselle P.M.
        • Litmanovich D.E.
        • Michaud G.
        • Roberts D.H.
        • Loring S.H.
        • Womble H.M.
        • et al.
        Dynamic expiratory tracheal collapse in morbidly obese COPD patients.
        COPD. 2013; 10: 604-610
        • Jones P.W.
        • Quirk F.H.
        • Baveystock C.M.
        The St George's respiratory questionnaire.
        Respir Med. 1991; 85 (discussion 33-7): 25-31
        • French C.T.
        • Irwin R.S.
        • Fletcher K.E.
        • Adams T.M.
        Evaluation of a cough-specific quality-of-life questionnaire.
        Chest. 2002; 121: 1123-1131
        • Peus D.
        • Newcomb N.
        • Hofer S.
        Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation.
        BMC Med Inform Decis Mak. 2013; 13: 72
        • Fletcher K.E.
        • French C.T.
        • Irwin R.S.
        • Corapi K.M.
        • Norman G.R.
        A prospective global measure, the Punum Ladder, provides more valid assessments of quality of life than a retrospective transition measure.
        J Clin Epidemiol. 2010; 63: 1123-1131
        • Puhan M.A.
        • Mador M.J.
        • Held U.
        • Goldstein R.
        • Guyatt G.H.
        • Schunemann H.J.
        Interpretation of treatment changes in 6-minute walk distance in patients with COPD.
        Eur Respir J. 2008; 32: 637-643
        • Litmanovich D.
        • O'Donnell C.R.
        • Bankier A.A.
        • Ernst A.
        • Millett M.E.
        • Loring S.H.
        • et al.
        Bronchial collapsibility at forced expiration in healthy volunteers: assessment with multidetector CT.
        Radiology. 2010; 257: 560-567
        • Buitrago D.H.
        • Gangadharan S.P.
        • Majid A.
        • Kent M.S.
        • Alape D.
        • Wilson J.L.
        • et al.
        Frailty characteristics predict respiratory failure in patients undergoing tracheobronchoplasty.
        Ann Thorac Surg. 2018; 106: 836-841
        • Haraldstad K.
        • Rohde G.
        • Stea T.H.
        • Lohne-Seiler H.
        • Hetlelid K.
        • Paulsen G.
        • et al.
        Changes in health-related quality of life in elderly men after 12 weeks of strength training.
        Eur Rev Aging Phys Act. 2017; 14: 8
        • Dajczman E.
        • Wardini R.
        • Kasymjanova G.
        • Prefontaine D.
        • Baltzan M.A.
        • Wolkove N.
        Six minute walk distance is a predictor of survival in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation.
        Can Respir J. 2015; 22: 225-229
        • Ekman M.J.
        • Klintenberg M.
        • Bjorck U.
        • Norstrom F.
        • Ridderstrale M.
        Six-minute walk test before and after a weight reduction program in obese subjects.
        Obesity (Silver Spring). 2013; 21: E236-E243
        • Buitrago D.H.
        • Majid A.
        • Alape D.E.
        • Wilson J.L.
        • Parikh M.
        • Kent M.S.
        • et al.
        Single-center experience of tracheobronchoplasty for tracheobronchomalacia: perioperative outcomes.
        Ann Thorac Surg. 2018; 106: 909-915