TRACHEOBRONCHOPLASTY PROVIDES LONG-TERM ANATOMIC, FUNCTIONAL, AND SUBJECTIVE BENEFIT FOR PATIENTS WITH SEVERE, DIFFUSE TRACHEOBRONCHOMALACIA

Abstract

SESSION TITLE: Clinical Outcomes in Cardiothoracic Surgery SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 1:30 PM - 2:30 PM PURPOSE: Tracheobronchoplasty significantly improves quality of life in patients with tracheobronchomalacia when assessed at 3 months post-operatively. This study examines the mid-term (1-2 years) and long-term (5 years) effect of tracheobronchoplasty on expiratory collapse, six minute walk duration, and quality of life scores in patients with tracheobronchomalacia. METHODS: This was a single institution retrospective review study consisting of sequential patients that underwent tracheobronchoplasty 2002 – 2016. Cross-sectional area of central airways were measured at the proximal and distal trachea, bilateral mainstem bronchi and bronchus intermedius. Expiratory collapse was calculated as the difference between inspiratory and expiratory cross-sectional areas, divided by inspiratory cross-sectional area. Primary outcome was improvement of expiratory collapse at years 1, 2, and 5 following tracheobronchoplasty. Secondary outcomes included mean response profile for dyspnea scale, six minute walk test, and cough quality score. Repeated-measures analysis of variance was used for statistical analyses. RESULTS: The cohort included 50 patients who had repeated airway measures of the central airway throughout duration of the study. Their median age was 58 years (interquartile range [IQR], 51-63 years). Preoperative mean expiratory collapse was 70% ± 19.5 in the upper trachea, 75% ± 21 in the lower trachea, 72.3± 20.2 in the right mainstem bronchus (RMSB) 73% ± 20 in the bronchus intermedius (BI), and 70± 19.5 in the left mainstem bronchus (LMSB). Overall, there is a significant linear decrease in the percentage of mean expiratory collapsibility of the central airways following tracheobronchoplasty over time. This effect is most significant at year 1 in the upper (70% vs. 45%, P<0.001) and lower trachea (75% vs. 38%, P <0.001) as well as the RMSB (73% vs. 31%, P <0.001). Radiographic repair durability was observed at years 2 and 5, though after year 2 the effect is less prominent in the BI and LMSB. Concordant to radiographic findings, we also observed significant improvement in the six minute walk test (1079 vs. 1268 ft, P <0.001), Karnofsky score (65 vs. 82, P <0.001) and cough specific quality of life score (68 vs. 55, P <0.001). Comparable findings were demonstrated in quality of life indices. CONCLUSIONS: Tracheobronchoplasty has durable salutary effects on airway anatomy, functional status, and symptoms in a carefully selected cohort of patients suffering from severe tracheobronchomalacia. Continued follow-up study is warranted, as is analysis of the subset of patients who did not have long-term benefit. CLINICAL IMPLICATIONS: Herein, we have shown the positive mid- and long-term effect of tracheobronchoplasty on expiratory collapsibility in patients with severe diffuse tracheobronchomalacia. These findings may help guide decision making for patients considering this effective, though arduous procedure. DISCLOSURES: No relevant relationships by Abraham Bezuidenhout, source=Web Response No relevant relationships by Daniel Buitrago, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 03/15/2019 by Alex Chee, source=Web Response, value=Consulting fee research relationship with On Target Laboratories Please note: >$100000 Added 03/13/2019 by Sidhu Gangadharan, source=Web Response, value=Grant/Research Support No relevant relationships by Diana Litmanovich, source=Web Response Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 03/16/2019 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with olympus Please note: $5001 - $20000 Added 03/16/2019 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with pinacle biologics Please note: $1001 - $5000 Added 03/16/2019 by Adnan Majid, source=Web Response, value=Consulting fee Consultant relationship with cook medical Please note: $1001 - $5000 Added 03/16/2019 by Adnan Majid, source=Web Response, value=Consulting fee No relevant relationships by Yehuda Malul, source=Web Response No relevant relationships by Mihir Parikh, source=Web Response No relevant relationships by Jennifer Wilson, source=Web Response