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Tracheobronchoplasty yields long-term anatomy,function, and quality of life improvement for patients with severe excessive central airway collapse |
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| Institution: | 1. Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Mass;2. Department of Radiology, Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass;1. Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass;2. Tufts Medical School, Boston, Mass;3. Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass;4. Division of Acute Care Surgery, Trauma, and Surgical Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass;1. Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States;2. Department of Medicine, Division of Hematology/Oncology, Lahey Hospital & Medical Center, Burlington, MA, United States;3. Department of Surgery, Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States;4. Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States;5. Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States;1. Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Md;2. Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md;3. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md;4. Maryland Cardiac Surgery Quality Initiative, Inc, Baltimore, Md;5. Division of Cardiothoracic Surgery, Suburban Hospital, Bethesda, Md;6. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md;7. Adventist Healthcare White Oak Medical Center, Silver Spring, Md;1. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pa;2. Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, Pa;3. Department of Breast Neoplastic Surgery (25th Ward), Hunan Tumor Hospital, The Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China;4. Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China;5. Department of Anesthesia, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China;6. Department of Respiratory Medicine, Huashan Hospital, Fudan University School of Medicine, Shanghai, China;7. Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa;8. Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pa;1. University of Arizona College of Medicine–Phoenix Campus, Phoenix, Ariz;2. Norton Thoracic Institute Research Laboratory, St Joseph''s Hospital and Medical Center, Phoenix, Ariz;3. Division of Thoracic Surgery, Norton Thoracic Institute, St Joseph''s Hospital and Medical Center, Phoenix, Ariz |
| Abstract: | ObjectivesThis study examines the long-term anatomic and clinical effects of tracheobronchoplasty in severe excessive central airway collapse.MethodsIncluded 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.ResultsThe 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).ConclusionsTracheobronchoplasty has durable effects on airway anatomy, functional status, and quality of life in carefully selected patients with severe excessive central airway collapse. |
| Keywords: | excessive central airway collapse excessive dynamic airway collapse tracheobronchomalacia tracheobronchoplasty quality of life BI"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"bronchus intermedius CT"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"computed tomography CQLQ"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"Cough-Specific Quality of Life Questionnaire ECAC"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"excessive central airway collapse IQR"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"interquartile range KPS"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"Karnofsky Performance Status LMSB"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"left mainstem bronchus MCID"} {"#name":"keyword" "$":{"id":"kwrd0110"} "$$":[{"#name":"text" "_":"minimal clinically important difference TBM"} {"#name":"keyword" "$":{"id":"kwrd0120"} "$$":[{"#name":"text" "_":"tracheobronchomalacia TBP"} {"#name":"keyword" "$":{"id":"kwrd0130"} "$$":[{"#name":"text" "_":"tracheobronchoplasty QOL"} {"#name":"keyword" "$":{"id":"kwrd0140"} "$$":[{"#name":"text" "_":"quality of life SGRQ"} {"#name":"keyword" "$":{"id":"kwrd0150"} "$$":[{"#name":"text" "_":"St George Respiratory Questionnaire 6MWT"} {"#name":"keyword" "$":{"id":"kwrd0160"} "$$":[{"#name":"text" "_":"6-minute walk test |
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