Long-term evaluation of the replacement of the trachea with an autologous aortic graft.
| Autor: | Martinod E; Laboratoire d'Etude des Greffes et Prothèses Cardiaques, Hôpital Broussais, Upres 264, Université Paris 6, France. emartinod@wanadoo.fr, Seguin A, Pfeuty K, Fornes P, Kambouchner M, Azorin JF, Carpentier AF |
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| Jazyk: | angličtina |
| Zdroj: | The Annals of thoracic surgery [Ann Thorac Surg] 2003 May; Vol. 75 (5), pp. 1572-8; discussion 1578. |
| DOI: | 10.1016/s0003-4975(03)00120-6 |
| Abstrakt: | Background: Tracheal reconstruction after extensive resection remains a challenge in thoracic surgery. The goal of this experimental study was to analyze the long-term evolution of tracheal replacement using an autologous aortic graft. Methods: In 21 sheep, a 5-cm segment of the cervical trachea was replaced by a segment of the descending thoracic aorta that was reconstructed to a prosthetic graft. Because of the airway collapse reported in a previous series, a permanent (n = 13) or temporary (n = 8) stent was systematically placed in the lumen of the graft. Clinical, bronchoscopic, and histologic examinations were performed up to 3 years after implantation. Results: All animals survived the operation with no paraplegia. In the group with a permanent stent, three complications occurred: one stent displacement, one laryngeal edema, and one infection. Stent removal was tolerated after 6 months in the group with a temporary stent. Histologic examination showed a progressive transformation of the arterial segment into first extensive inflammatory tissue with a squamous epithelium, and after 6 to 36 months well-differentiated tracheal tissue including a continuous mucociliary epithelium and regular rings of newly formed cartilage. Conclusions: An autologous aortic graft used as a substitute for extensive tracheal replacement in sheep remained functional for periods up to 3 years. The progressive transformation of the graft into a structure resembling tracheal tissue seems to be a key factor in long-term patency. The mechanism of this regenerative process and the possibility of using arterial homografts, which would make clinical application easier, remain to be evaluated. |
| Databáze: | MEDLINE |
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