Airway spray cryotherapy: initial outcomes from a multiinstitutional registry.

BACKGROUND: Spray cryotherapy (SCT) uses a noncontact system to deliver liquid nitrogen (2 to 4 psi) through an endoscopic catheter. Rapid freezing and thawing of tissue causes cellular death and is also hemostatic. We report the preliminary results from 6 institutions in which SCT was used for the treatment of malignant airway tumors. METHODS: SCT was performed on patients with symptomatic airway tumors and reviewed retrospectively. Airway narrowing was graded as 25% or smaller, 26% to 50%, 51% to 75%, and exceeding 75%. All events were documented and assessed. RESULTS: Eighty patients (45 male [56%]) underwent 114 treatments. Median age was 66 years (range, 15 to 90 years). All patients were treated with minimal blood loss. Fifty-eight percent of the cases were outpatient procedures. Airway obstruction exceeded 75% in most of the lesions treated. There were 21 intraoperative events (19%), including hypotension, bradycardia and tachycardia, ST segment changes, desaturation, and an airway tear. Three pneumothoraces occurred, one requiring emergency chest tube placement. Two intraoperative deaths were associated with bradycardia. Three postoperative deaths occurred in patients who were transitioned to comfort care. All but 1 patient had airway patency after treatment. CONCLUSIONS: SCT can be used in patients with highly vascular tumors, with reduced bleeding complications and a low overall complication rate. Caution is needed before SCT is used on a widespread basis, given the intraoperative complications. Although the potential benefit of SCT is considerable, this needs to be confirmed in larger studies.

Endoscopic therapies and stents for benign airway disorders: where are we, and where are we heading?

Benign strictures of the airway can be complex and challenging to manage. Although resection has the best long-term results, this is not always feasible, and there will be groups of patients who require additional therapy for failure after open operations or who are not surgical candidates and require endoluminal management. A number of stents are available; however, not all perform well for the longer duration that will be required for patients with benign compared with malignant strictures. For this reason, stenting should be considered a temporary solution or a last resort for patients with benign airway strictures. Combinational modalities hold promise; for example, radial laser incisions with dilatation and mitomycin C for tracheal stenosis. Many techniques, however, have been associated with failure, particularly for long strictures. Spray cryotherapy is a new technique that may have advantages over other treatments by modulating the healing response and resulting in improved healing and less refibrosis. A number of current and new therapies are reviewed in this article.

Aortomyoplasty: hemodynamics and comparison to the intraaortic balloon pump.

BACKGROUND: Aortomyoplasty (AMP), a procedure in which the latissimus dorsi muscle (LDM) is wrapped around the aorta and stimulated during diastole, is a potential method of chronic counterpulsation. Counterpulsation by the intraaortic balloon pump (IABP) is a proven treatment for ischemic coronary syndrome and heart failure but cannot be used chronically. This study examined the long-term potential of a unique AMP configuration and compared its performance to the IABP. MATERIALS AND METHODS: AMP was done using a wringer configuration (AMP-W) in nine dogs. Six and 12 months later, acute hemodynamic augmentation was evaluated by measuring differences in mean diastolic aortic pressure (mDAP), peak left ventricular pressure (pLVP), and the endocardial viability ratio (EVR) between stimulated and unstimulated beats. RESULTS: The diastolic augmentation obtained by AMP-W at 6 months and by AMP-W and IABP at 12 months was statistically significant. Additionally, the enhancements in EVR (16.1 +/- 4.3%), mDAP (8.6 +/- 2.5%), and pLVP (-1.8 +/- 1.0%) at 6 months were similar to those in EVR (19.1 +/- 5.2%), mDAP (13.1 +/- 3.6%), and pLVP (-0.8 +/- 1.3%) at 12 months. Most importantly, the augmentation obtained by AMP-W at 12 months was similar to that of the IABP: EVR (17.1 +/- 5.9%), mDAP (13.4 +/- 6.7%), and pLVP (-1.5 +/- 0.8%). CONCLUSIONS: AMP-W is a safe, robust procedure, capable of providing counterpulsation equivalent to the IABP, 12 months following surgery. The potential for AMP-W to offer chronic counterpulsation and to benefit the ischemic heart should be investigated further.