Tracheobronchial Membrane Tapering Resection for Tracheobronchomalacia With Wide Posterior Membrane

Tracheobronchomalacia is characterized by excessive dynamic airway collapse, often associated with a wide posterior membrane. This report describes outcomes of an innovative tapering membrane reduction tracheobronchoplasty (TMRT) designed to narrow the posterior membrane and improve functional airway stability.

This was a retrospective study of patients who underwent TMRT for severe tracheobronchomalacia with a wide posterior membrane from 2022 to 2024 at 2 institutions. Under bronchoscopic guidance, a longitudinal strip of posterior membrane was resected, with concurrent 2-layered longitudinal closure. Patients' characteristics and outcomes were analyzed.

A total of 85 patients (male, 65%; esophageal atresia, 66%) underwent TMRT at median age of 30 months (range, newborn to 21 years). Common indications included recurrent respiratory infections (41%), inability to be weaned from positive pressure ventilation (21%), and blue spells (18%). The tapered segment was tracheal (68%), bronchial (5%), and both (27%). Concomitant procedures included posterior tracheobronchopexy (96%), posterior descending aortopexy (7%), and esophageal repair (35%). Median follow-up was 22 months (interquartile range, 18-26 months). Significant improvements were seen in blue spells, respiratory infections, and ability to be weaned from ventilation or supplemental oxygen (P < .05). Complications included esophageal leak (4%), transient vocal fold dysfunction (7%), chylothorax (4%), dysphagia requiring esophageal dilation (8%), and tracheal stenosis requiring dilation (1%). Four patients (5%) required subsequent airway procedures. There were no fatalities.

TMRT is feasible and safe for severe tracheobronchomalacia with a wide posterior membrane and is associated with substantial early improvement in functional airway stability and respiratory outcomes. Further study is needed to assess long-term durability and broader applicability.