A New Approach For Tetralogy Of Fallot With Absent Pulmonary Valve Associated With Tracheobronchomalacia Using A Bioresorbable 3D-Printed Airway Splint
John Vossler, MD, MS, MBA, Glenn Green, MD, Andrea Les, PhD, Richard Ohye, MD.
University of Michigan, Ann Arbor, MI, USA.
Objective(s): Tetralogy of Fallot with absent pulmonary valve (TOF-APV) is associated with severe tracheobronchomalacia (TBM) and significant airway compromise. These patients often require early repair with right ventricle-to-pulmonary artery conduit, tracheostomy, and long-term ventilator support. A bioresorbable, 3D-printed airway splint has been shown to be effective in treating severe TBM. The splint has the potential to obviate the need for early repair with conduit and tracheostomy.
Methods: A retrospective case series analysis was conducted on consecutive patients with TOF-APV and severe TBM who underwent airway splinting between 2012 and 2021. Clinical data was extracted from the medical record. Patients were grouped and analyzed according to their sequence of procedures. IRB approval for this study was obtained (HUM00223004).
Results: Eight patients with TOF-APV and severe TBM underwent airway splinting with a median follow up of 691 days (range 14-2135). All patients were alive at most recent follow up. Five patients underwent complete cardiac repair first, and one patient underwent concurrent complete cardiac repair and airway splinting. All six required tracheostomy and long-term ventilator support, even after airway splinting. Five of six remained on ventilator support at most recent follow up. The remaining two patients underwent primary airway splinting before complete cardiac repair. Neither required tracheostomy or prolonged ventilatory support (p=0.036). Both underwent subsequent elective TOF repair without conduit.
Conclusions: Patients with TOF-APV and severe TBM may be able to avoid early repair with conduit placement and tracheostomy by undergoing airway splinting prior to complete cardiac repair.
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