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
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
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Article info
Publication history
Published online: June 07, 2022
Accepted:
May 30,
2022
Received in revised form:
May 3,
2022
Received:
August 12,
2021
Footnotes
Beth Israel Deaconess Medical Center Institutional Review Board (Protocol No. 2005P-000112), approved July 2005.
Presented at the 2019 Annual Meeting of the American College of Chest Physicians, New Orleans, Louisiana.
Identification
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© 2022 by The American Association for Thoracic Surgery
