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Outcomes of surgical treatment of tracheobronchomalacia in children.

Authors :
Mukharesh L
Krone KA
Hamilton TE
Shieh HF
Smithers CJ
Winthrop ZA
Muise ED
Jennings RW
Mohammed S
Demehri FR
Zendejas B
Visner GA
Source :
Pediatric pulmonology [Pediatr Pulmonol] 2024 Jul; Vol. 59 (7), pp. 1922-1931. Date of Electronic Publication: 2024 Apr 17.
Publication Year :
2024

Abstract

Background: Tracheobronchomalacia (TBM) is characterized by excessive dynamic airway collapse. Severe TBM can be associated with substantial morbidity. Children with secondary TBM associated with esophageal atresia/tracheoesophageal fistula (EA/TEF) and vascular-related airway compression (VRAC) demonstrate clinical improvement following airway pexy surgery. It is unclear if children with severe primary TBM, without secondary etiologies (EA/TEF, vascular ring, intrinsic pulmonary pathology, or complex cardiac disease) demonstrate clinical improvement following airway pexy surgery.<br />Materials and Methods: The study cohort consisted of 73 children with severe primary TBM who underwent airway pexy surgery between 2013 and 2020 at Boston Children's Hospital. Pre- and postoperative symptoms as well as bronchoscopic findings were compared with Fisher exact test for categorical data and Student's t-test for continuous data.<br />Results: Statistically significant improvements in clinical symptoms were observed, including cough, noisy breathing, prolonged respiratory infections, pneumonias, exercise intolerance, cyanotic spells, brief resolved unexplained events (BRUE), and noninvasive positive pressure ventilation (NIPPV) dependence. No significant differences were seen regarding oxygen dependence, ventilator dependence, or respiratory distress requiring NIPPV. Comparison of pre- and postoperative dynamic bronchoscopy findings revealed statistically significant improvement in the percent of airway collapse in all anatomic locations except at the level of the upper trachea (usually not malacic). Despite some initial improvements, 21 (29%) patients remained symptomatic and underwent additional airway pexies with improvement in symptoms.<br />Conclusion: Airway pexy surgery resulted in significant improvement in clinical symptoms and bronchoscopic findings for children with severe primary TBM; however, future prospective and long-term studies are needed to confirm this benefit.<br /> (© 2024 Wiley Periodicals LLC.)

Details

Language :
English
ISSN :
1099-0496
Volume :
59
Issue :
7
Database :
MEDLINE
Journal :
Pediatric pulmonology
Publication Type :
Academic Journal
Accession number :
38629381
Full Text :
https://doi.org/10.1002/ppul.27012