Scoliotic deformity represents a serious spinal disorder that influences the locomotive and cardiopulmonary systems. Some patients with severe scoliosis and end-stage lung disease are therefore denied lung transplantation. In patients with scoliosis considering lung transplantation, size match, straight back syndrome, delayed chest closure and bronchial stenosis are key issues clinicians should evaluate. Therefore, it is vital to determine donor-recipient size matches very precisely. Chest opening is a routine intraoperative primary therapeutic procedure after lung transplantation in unstable patients with oversized transplanted lungs. Postoperative bronchial stenosis occurs predominantly on the right side and is usually handled through interventional bronchoscopy and the insertion of stents. This report describes the complex case of a patient with scoliosis who underwent lobar transplantation in our center.

• Klíčová slova
• Bronchial stenosis, Delayed chest closure, Lung transplantation, Scoliosis, Straight back syndrome,
• MeSH
• bronchiální nemoci * chirurgie   etiologie   MeSH
• lidé MeSH
• skolióza * komplikace   chirurgie   MeSH
• stenóza chirurgie   MeSH
• sternum * chirurgie   MeSH
• transplantace plic * metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Biodegradable (BD) stents made from polydioxanone have been used only in human airways. These stents combine the advantages of classical tracheal stents, and fewer side effects are expected due to their biocompatibility and their time-limited presence in airways. However, new clinical consequences have arisen. Here, the authors share their experiences with BD stents for tracheal indications, focusing on their safety and efficacy. METHODS: This was a retrospective review of a collected database of adult patients who underwent implantation of biodegradable tracheal stents between September 2013 and December 2022 at the Department of Respiratory Medicine of the 1st Faculty of Medicine in Prague and Thomayer University Hospital. The indications included functionally significant nonmalignant tracheal stenosis and tracheomalacia. Self-expandable, biodegradable, polydioxanone tracheal stents manufactured by ELLA-CS Ltd. (Hradec Kralove, Czech Republic) were implanted during rigid bronchoscopy under general anaesthesia. All patients were followed up in the department and were provided with the necessary care. The main efficacy and safety parameters and relationships were analysed using descriptive statistics and Fisher´s exact, Wilcoxon and Kruskal‒Wallis tests. RESULTS: A total of 65 stents were implanted in 47 adult patients. During the first two months after implantation, when adequate function was expected, the stent was found to be effective in 26 out of 39 patients who completed this period (66.7%). The clinical effectiveness reached 89.7%, as early restenoses were mostly mild and necessitated treatment in only 4 patients. The frequencies of significant mucostasis, migration and granulation tissue growth were 2.6%, 7.5% and 23.1%, respectively, during this period. Thirty-four participants completed the half-year follow-up period after the first or second stent insertion, and some were followed up beyond this period. Poor control of symptoms, the development of restenosis and the need for interventions were characteristic of this period as the stents degraded. Twenty-two patients who experienced remodelling or stabilization of the tracheal lumen achieved a stent-free state. Seven patients underwent subsequent surgical treatment. CONCLUSIONS: BD stents are safe and provide adequate tracheal support until they begin to degrade. The use of BD stents necessitates close monitoring of patients and accurate treatment of possible restenosis. TRIAL REGISTRATION: Based on project NT14146 - Biodegradable stents in the management of the large airways (2013-2015, MZ0/NT), registered on May 1, 2013, in the Research and Development and Innovation Information System of the Czech Republic and at ClinicalTrials.gov (reg. no. NCT02620319, December 2, 2015).

• Klíčová slova
• Biodegradable, Bronchoscopy, Interventional pneumology, Polydioxanone, Stents, Tracheal stenosis,
• MeSH
• bronchoskopie * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• polydioxanon MeSH
• protézy - design MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stenóza průdušnice * chirurgie   MeSH
• stenty * MeSH
• trachea chirurgie   MeSH
• tracheomalacie chirurgie   MeSH
• vstřebatelné implantáty * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Biodegradable stents that disintegrate after a period of time are expected to be well tolerated and have advantages over other stents that are more commonly used in practice today. Polydioxanone is a biodegradable polymer that is widely used during surgery with absorbable sutures. METHODS: We present cases from the first four patients to undergo a tracheal polydioxanone stent insertion. Indications included significant non-malignant tracheal stenosis in cases where primary surgical treatment was not possible. The stents were implanted using rigid bronchoscopy and patients received regular follow-ups as needed. This use of biodegradable stents in adult patients was a novel, previously untested approach. The study was approved by the Institutional Ethics Committee and was based on a project entitled; "Biodegradable stents in the management of stenoses of large airways" (project NT 14146-3/2013). RESULTS: Six biodegradable stents were implanted in four patients with benign stenoses. No technical difficulties occurred and no serious or life-threatening events were recorded. All patients reported some benefit from treatment. CONCLUSION: Polydioxanone tracheal stents can be considered when a need for temporary support is expected, and as an alternative to other stents if the latter could compromise the patient. Owing to limited experience and observed disadvantages, further research is needed to fully assess this treatment. TRIAL REGISTRATION: This work is based on project NT14146 - Biodegradable stents in the management of stenoses of the large airways (2013-2015, MZ0/NT), registered from May 1, 2013 in The Research and Development and Innovation Information System of the Czech Republic and in ClinicalTrials.gov, reg. no. NCT02620319, December 2, 2015.

• MeSH
• biokompatibilní materiály chemie   MeSH
• bronchoskopie MeSH
• lidé středního věku MeSH
• lidé MeSH
• polydioxanon chemie   MeSH
• senioři MeSH
• stenóza průdušnice chirurgie   MeSH
• stenty klasifikace   MeSH
• trachea chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• biokompatibilní materiály MeSH
• polydioxanon MeSH