Tracheobronchoplasty for Excessive Dynamic Airway Collapse and Tracheobronchomalacia: A Comparative Analysis of Distinct Airway Disorders.

Abstract

Excessive dynamic airway collapse (EDAC) and tracheobronchomalacia (TBM) are distinct causes of excessive central airway collapse; EDAC is characterized by excessive anterior displacement of the posterior membrane, whereas TBM is due to weakness of the cartilaginous rings. We compared outcomes after tracheobronchoplasty across these 2 pathologic processes. This was a single-center retrospective study including patients who underwent tracheobronchoplasty between 2018 and 2023. Preoperative dynamic computed tomography scans were reviewed by 4 airway experts, and patients were assigned to 2 groups (EDAC and TBM) on the basis of consensus diagnosis. The study included 73 consecutive patients who underwent tracheobronchoplasty with a consensus diagnosis of EDAC (n = 47) or TBM (n = 26). Patients with EDAC were less likely to have diabetes (15% vs 54%; P < .01) and more likely to undergo robotic tracheobronchoplasty (30% vs 4%; P = .01). There were no significant differences in rates of minor complications (60% vs 81%; P = .07), major complications (21% vs 35%; P = .17), or overall Clavien-Dindo scores (21 vs 21.75; P = .21). Intensive care unit and hospital length of stay, rates of 30-day readmissions, and home discharges were also similar. Both groups achieved clinically meaningful improvements in quality of life score and 6-minute walk test distance at the first follow-up. Differentiating EDAC and TBM is challenging for clinicians because of the overlapping clinical symptoms. Despite anatomic differences, surgical outcomes are comparable. This supports the role of tracheobronchoplasty as a definitive treatment of excessive central airway collapse, regardless of cause. Diagnostic differentiation remains important for mechanistic understanding but should not preclude surgical candidacy.