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Ann Thorac Surg 2003;75:1572-1578
© 2003 The Society of Thoracic Surgeons

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Original article: general thoracic

Long-term evaluation of the replacement of the trachea with an autologous aortic graft

^a Laboratoire d’Etude des Greffes et Prothèses Cardiaques, Hôpital Broussais, Upres 264, Université Paris 6, France
^b Department of Thoracic and Vascular Surgery, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris and UFR SMBH, Bobigny, Université Paris 13, France

Accepted for publication January 7, 2003.

^* Address reprint requests to Dr Martinod, Service de Chirurgie Thoracique et Vasculaire, Hôpital Avicenne, 125 route de Stalingrad, 93000 Bobigny, France.
e-mail: emartinod{at}wanadoo.fr

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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