Sidhu P. Gangadharan, MD, Charles T

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Technical Aspects and Outcomes of Tracheobronchoplasty for Severe Tracheobronchomalacia Sidhu P. Gangadharan, MD, Charles T. Bakhos, MD, Adnan Majid, MD, Michael S. Kent, MD, Gaetane Michaud, MD, Armin Ernst, MD, Simon K. Ashiku, MD, Malcolm M. DeCamp, MD The Annals of Thoracic Surgery Volume 91, Issue 5, Pages 1574-1581 (May 2011) DOI: 10.1016/j.athoracsur.2011.01.009 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A schematic of malacic airway pathology in cross-section, and correction with tracheobronchoplasty is shown. (A) Airway (1) represents the form of tracheobronchomalacia (TBM) that primarily affects the cartilage, causing lateral migration of the cartilaginous-membranous junction and decreased ratio of sagittal:coronal diameter; a representative computed tomography scan image accompanies the diagram. Airway (2) represents the form of TBM that primarily is manifest by membranous wall intrusion into the lumen of the airway, with relative preservation of coronal diameter; a representative computed tomography scan image accompanies the diagram, and a normal airway cross-section is also depicted. (B) Posterior splinting is depicted. The mesh is represented by the cross-hatched rectangle, and the suture is seen passed in partial-thickness, mattressed fashion through the airway wall. (C) After sutures are tied down, any redundancy of the membranous wall is pleated to the mesh, and the D-shape of the airway is restored. Reprinted from Gangadharan [7]. The Annals of Thoracic Surgery 2011 91, 1574-1581DOI: (10.1016/j.athoracsur.2011.01.009) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 A photograph of tracheobronchoplasty is shown. (A) Partial-thickness sutures are placed in rows across the posterior membrane at the level of the carina. The single arrow marks the row at the distal trachea; double arrows mark the row across the proximal right mainstem bronchus. (B) Polypropylene mesh is parachuted into place after distal trachea and proximal left and right bronchial suture rows have been placed. (C) Appearance after the first rows of sutures are tied and the mesh is anchored to the posterior membrane. The Annals of Thoracic Surgery 2011 91, 1574-1581DOI: (10.1016/j.athoracsur.2011.01.009) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Baseline and transition dyspnea indices are shown. (A) The baseline dyspnea index (BDI) was measured preoperatively. (B) Transition dyspnea index scores were measured postoperatively: zero connotes no change from the intervention, −9 signifies marked deterioration in symptoms after treatment, and +9 signifies marked improvement in symptoms after treatment. The Annals of Thoracic Surgery 2011 91, 1574-1581DOI: (10.1016/j.athoracsur.2011.01.009) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions