Long-term evaluation of the replacement of the trachea with an autologous aortic graft.
Ann Thorac Surg
; 75(5): 1572-8; discussion 1578, 2003 May.
Article
em En
| MEDLINE
| ID: mdl-12735581
ABSTRACT
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.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Aorta Torácica
/
Traqueia
Limite:
Animals
Idioma:
En
Revista:
Ann Thorac Surg
Ano de publicação:
2003
Tipo de documento:
Article
País de afiliação:
França