Tracheobronchoplasty for severe tracheobronchomalacia: a case-series of patients with acute and chronic critical comorbidities.

Abstract

OBJECTIVES There is little data within the literature regarding tracheobronchoplasty (TBP) in the setting of the acute and chronically ill, morbidly obese, or ventilator dependent patients with Tracheobronchomalacia (TBM). Short- and long-term outcomes are studied. METHODS The series represents 12 TBM patients with American Society of Anesthesiologists (ASA) physical status scores of 3 to 5. Candidacy was based on bronchoscopic findings during spontaneous respirations with >90% collapse of the trachea and both mainstem bronchi. We used dynamic CT scan as an adjunct in those not mechanically ventilated. Our operative approach was a complete portal robotic approach for those outpatients (wheelchair dependent) and right thoracotomy for those who were already mechanically ventilated with 100% fraction of inspired oxygen (FiO2) with high pressure. Extracorporeal support was used in 2 patients. RESULTS Patients who underwent robotic repair, were discharged without complications. Two patients who were critically ill and required extracorporeal support for their surgeries, were separated from extracorporeal membrane oxygenation (ECMO) on postoperative day 2. Three patients died at the follow-up. In 1 patient, the prolene mesh migrated into trachea and caused obstruction of the trachea and required removal with endobronchial techniques. CONCLUSIONS The repair of TBM in patients with multiple comorbidities and with severe life-threatening problems in or outside the ICU, may have improvement due to the ability to wean from positive pressure ventilation. Surgical technique and the utilization of mesh support in TBP operations may need to be debated due to duration of the surgery in patients with severe comorbidities.