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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
57th Annual Meeting Abstracts


Poster 21

Abstract Title

Predictors of the Need for Surgical Intervention in Cervical Tracheomalacia

 

 

Author Block

David D. Odell, MD1, Adnan Majid, MD1, Armin Ernst, MD1, Gaetane Michaud, MD1, Malcolm M. Decamp, MD2, Sidhu P.Gangadharan, MD1

1Beth Israel Deaconess MedicalCenter, Boston, MA  2Northwestern MemorialHospital, Chicago, IL

 

Abstract Body

Background: Tracheal malacia(TM) is excessive airway collapse resulting in respiratory compromise or failure. Effect of disease and treatment options remain uncharacterized in the cervical trachea.

Methods: Review of patients evaluated for tracheobronchial malacia(TBM) from 1/2000-8/2009 at a tertiary airway center. Patient demographics, baseline physiology and initial bronchoscopic evaluations were examined. Patients with CM were identified by cervical airway collapse on dynamic bronchoscopy.

Results: We identified 44 patients with CM among 189 patients with TBM(23%). CM occurred concomitantly with both distal tracheomalacia(98%) and bronchomalacia(93%). Patients presented with shortness of breath(84%), cough(57%) and recurrent infections(50%). COPD(46%) and GERD(36%) were the most frequent co-morbid medical conditions. Compared to patients with distal TBM, CM patients did not have significantly different baseline pulmonary function, exercise capacity or dyspnea indices though were more likely to have undergone tracheostomy(14% vs 2%; p=0.04). Treatment involved intervention for distal TBM with tracheal stent placement in 39 of 44 patients and subsequent surgical tracheobronchoplasty(TBP) in 27. Persistent symptoms required cervical intervention in 9 patients treated by TBP and one with isolated CM. These ten patients underwent 12 cervical airway interventions including tracheal resection(5), cervical airway stenting(5), or T-tube placement(2). Presenting symptoms and pulmonary function testing were not predictive of the need for cervical intervention. However, patients requiring cervical intervention were significantly more likely to have concomitant obstructive sleep apnea(p=0.03) or reflux disease(p=0.02).

Conclusion: Operative stabilization of the cervical trachea is required in only a subset of CM patients. Further examination of the relationship between GERD, OSA and the development of CM is necessary.

 

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