ASPO048 - Introducing an ex vivo model of posterior tracheomalacia with evaluation of potential treatment modalities
Saturday, April 30, 2022
4:00 PM – 5:00 PM CT
Location: Landmark B
Angela Cao, MD1, Pooja Swami, MS2, Rachel Kaye, MD3, Todd Goldstein, PhD2, Daniel A. Grande, PhD2, Lee P. Smith, MD4;
1Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein Sch. of Med./Montefiore Med. Ctr., Bronx, NY, 2The Feinstein Institute of Research, The Donald and Barbara Zucker Sch. of Med. at Hofstra/Northwell Health, Hempstead, NY, 3Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Med. Sch., Rutgers, NJ, 4Department of Otolaryngology-Head and Neck Surgery, Long Island Jewish Med. Ctr., Steven and Alexandra Cohen Children’s Med. Ctr., New Hyde Park, NY.
Resident Montefiore Medical Center Bronx, New York
Introduction: Posterior tracheomalacia is characterized by excessive intraluminal displacement of the membranous wall of the trachea. Recently, novel surgical strategies for repair of posterior tracheomalacia have been introduced. To our knowledge, these strategies have not been evaluated in an ex vivo mechanical model of posterior tracheomalacia. Thus, we sought to design an ex vivo model of posterior tracheomalacia and evaluate repair interventions including external splinting, posterior tracheopexy, and injection tracheoplasty.
Methods: A model for posterior tracheomalacia was established by creating partial thickness longitudinal incisions to the posterior segment of ex vivo porcine trachea. Three groups of porcine trachea were tested: 1) control (unmanipulated trachea), 2) posterior tracheomalacia (injured trachea), and 3) intervention (repaired trachea). Interventions included external splinting with 0.3 mm and 0.5 mm bioabsorbable mesh plates, posterior tracheopexy to a three-dimensional (3D) printed scaffold, and injection tracheoplasty with calcium hydroxylapatite (CaHA) filler. A closed system of the ex vivo trachea was created using custom 3D printed stoppers. A bronchoscope and pressure transducer were connected to either end to measure tracheal wall collapse with changes in negative pressure. Cross-sectional area of the tracheal lumen across decreasing pressure values were analyzed using ImageJ software (National Institutes of Health, Bethesda, MD).
Results: Average percent reduction in cross-sectional area of the tracheal lumen was compared using two-tailed paired T-test. Significant differences were found between control and tracheomalacia groups (P < 0.001). There was no significant difference between control and external splinting and posterior tracheopexy groups (P > 0.14). There was no significant difference between injection tracheoplasty and tracheomalacia groups.
Conclusion: We describe an ex vivo model for posterior tracheomalacia that replicates airway collapse. Both external splinting and tracheopexy interventions showed recovery of the injured tracheal segment. CaHA injection tracheoplasty did not improve upon the tracheomalacia.