Advertisement

Advanced Therapies for Severe Tracheobronchomalacia: A Review of the Use of 3D-Printed, Patient-Specific, Externally Implanted, Bioresorbable Airway Splints

  • Vikram Sood
    Affiliations
    Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, C.S. Mott Children's Hospital, University of Michigan Medicine, Ann Arbor, Michigan
    Search for articles by this author
  • Glenn E. Green
    Affiliations
    Department of Otolaryngology—Head and Neck Surgery, C.S. Mott Children's Hospital, University of Michigan Medicine, Ann Arbor, Michigan
    Search for articles by this author
  • Andrea Les
    Affiliations
    Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, C.S. Mott Children's Hospital, University of Michigan Medicine, Ann Arbor, Michigan

    Department of Otolaryngology—Head and Neck Surgery, C.S. Mott Children's Hospital, University of Michigan Medicine, Ann Arbor, Michigan
    Search for articles by this author
  • Richard G Ohye
    Correspondence
    Address reprint requests to Richard G Ohye, MD, Room 11-742, 1540 E. Hospital Drive/SPC 4204, Ann Arbor, MI 48109-4204.
    Affiliations
    Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, C.S. Mott Children's Hospital, University of Michigan Medicine, Ann Arbor, Michigan
    Search for articles by this author
      Tracheobronchomalacia is a condition of dynamic collapse of the trachea and mainstem bronchi. The clinical significance of tracheobronchomalacia depends on its severity. Mild cases may be medically managed with limited symptomology, while severe cases require advanced therapies, lengthy hospital stays, and carry significant morbidity and mortality. Current therapies for severe tracheobronchomalacia include tracheostomy with prolonged mechanical ventilation, aortopexy, tracheobronchopexy, and intraluminal metallic, silicone, or bioresorbable stents. Three-dimensional (3D)-printed, patient-specific, bioresorbable airway splinting is a novel treatment option that is undergoing investigation in a cohort of critically ill children with severe tracheobronchomalacia. At the time of our last review of our data, 29 splints had been implanted in 15 children with intrathoracic tracheobronchomalacia. The median follow-up was 8.5 months. There were 12 long-term survivors, and all but one lived at home. This article discusses the details of our institution's development and use of 3D-printed, patient-specific, bioresorbable splints for treatment of severe tracheobronchomalacia in the pediatric population.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Carden KA
        • Boiselle PM
        • Waltz DA
        • et al.
        Tracheomalacia and tracheobronchomalacia in children and adults: An in-depth review.
        Chest. 2005; 127: 984-1005
        • Kamran A
        • Baird CW
        • Jennings RW.
        Tracheobronchomalacia, tracheobronchial compression, and tracheobronchial malformations: Diagnostic and treatment strategies.
        Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2020; 23: 53-61
        • Fraga JC
        • Jennings RW
        • Kim PCW
        Pediatric tracheomalacia.
        Semin Pediatr Surg. 2016; 25: 156-164
        • Hysinger EB
        • Panitch HB
        Pediatric tracheomalacia.
        Paediatr Respir Rev. 2016; 17: 9-15
        • Boogard R
        • Huijsmans SH
        • Pijnenburg MWH.
        Chest. 2005; 128: 3391-3397
        • Valletta EA
        • Pregarz M
        • Bergamo-Andreis IA
        • et al.
        Tracheoesophageal compression due to congenital vascular anomalies.
        Pediatr Pulmonol. 1997; 24: 93-105
        • Carden KA
        • Boiselle PM
        • Waltz DA.
        Tracheomalacia and tracheobronchomalacia in children and adults: An in-depth review.
        Chest. 2005; 127: 984-1005
        • Choi S
        • Lawlor C
        • Rahbar R
        • et al.
        Diagnosis, classification, and management of pediatric tracheobronchomalacia: A review.
        JAMA Otolaryngol head Neck Surg. 2019; 145: 265-275
        • Wallis C
        • Alexopoulou E
        • Anton-Pacheco JL
        • et al.
        ERS statement on tracheomalacia and bronchomalacia in children.
        Eur Respir J. 2019; 541900382
        • Mitchell ME
        • Rumman N
        • Chun RH
        • et al.
        Anterior tracheal suspension for tracheobronchomalacia in infants and children.
        Ann Thorac Surg. 2014; 98: 1246-1253
        • McNamara VM
        • Crabbe DC
        Tracheomalacia.
        Paediatr Respir Rv. 2004; 5: 147-154
        • Finder JD.
        Primary bronchomalacia in infants and children.
        J Pediatr. 1997; 130: 59-66
        • Goyal V
        • Masters IB
        • Chang AB.
        Interventions for primary (intrinsic) tracheomalacia in children.
        Cochrane Database Syst Rev. 2012; 10CD005304
        • Vinograd I
        • Filler RM
        • Bahovic A.
        Long-term functional results of prosthetic airway splinting in tracheomalacia and bronchomalacia.
        J Pedatr Surg. 1987; 22: 38-41
        • Amedee RG
        • Mann WJ
        • Lyons GD.
        Tracheomalacia repair using ceramic rings.
        Otolaryngol Head Neck Surg. 1992; 106: 270-274
        • Shieh HF
        • Jennings RW.
        Three-dimensional printing of external airway splints for tracheomalacia.
        J Thorac Dis. 2017; 9: 414-416
        • Zopf DA
        • Hollister SJ
        • Nelson ME
        • et al.
        Bioresorbable airway splint created with a three-dimensional printer.
        N Engl J Med. 2013; 368: 2043-2045
        • Les AS
        • Ohye RG
        • Filburn AG
        • et al.
        3D-Printed, externally-implanted, bioresorbable airway splints for severe tracheobronchomalacia.
        Laryngoscope. 2019; 129: 1763-1771
        • Morrison RJ
        • Hollister SJ
        • Niedner MF
        • et al.
        Mitigation of tracheobronchomalacia with 3D-printed personalized medical devices in pediatric patients.
        Sci Transl Med. 2015; 7: 285ra64
        • Zopf DA
        • Flanagan CL
        • Wheeler M
        • et al.
        Treatment of severe porcine tracheomalacia with a 3 dimensionally printed, bioresorbable, external airway splint.
        JAMA Otolaryngol Head Neck Surg. 2014; 140: 66-71
        • Low SW
        • Ng YKL
        • Yeo TT
        • et al.
        Use of Osteoplug polycaprolactone implants as novel burr-hole covers.
        Singapore Med J. 2009; 50: 777-780
        • Hollister SJ
        • Flanagan CL
        • Zopf DA
        • et al.
        Design control for clinical translation of 3D printed modular scaffolds.
        Ann Biomed Eng. 2015; 43: 774-786