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

This article presents the first comparative analysis of outcomes after tracheobronchoplasty (TBP) for excessive dynamic airway collapse (EDAC) and tracheobronchomalacia (TBM), two distinct but often conflated causes of excessive central airway collapse (ECAC). In this single-center retrospective study of 73 patients (47 with EDAC and 26 with TBM), the authors used dynamic CT imaging reviewed by airway experts to establish a gold-standard diagnosis. Despite anatomical and pathophysiologic differences, postoperative outcomes were comparable between EDAC and TBM in terms of complication rates, intensive care units (ICU) and hospital stays, readmissions, and quality-of-life improvements. Both groups experienced significant gains in respiratory symptoms and six-minute walk test performance following TBP. 
 
The study highlights that while differentiating EDAC from TBM remains diagnostically challenging, these distinctions do not translate into differences in surgical benefit, supporting TBP as a definitive and effective treatment for severe ECAC regardless of the cause. Importantly, the findings underscore the need for refined diagnostic standards, multidisciplinary evaluation, and expanded surgical candidacy criteria. 
 
For the global cardiothoracic surgery audience, this paper is significant because it clarifies disease mechanisms and outcomes for a rare but increasingly recognized cause of airway obstruction. It informs evolving robotic and open TBP approaches, emphasizes the importance of multidisciplinary collaboration between surgeons and interventional pulmonologists, and sets the stage for multicenter efforts to standardize diagnosis and management of complex airway disorders.