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Ann Thorac Surg 2009;87:861-867. doi:10.1016/j.athoracsur.2008.11.038
© 2009 The Society of Thoracic Surgeons
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Agathe Seguin
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Original Articles: General Thoracic

Tracheal Replacement With Cryopreserved, Decellularized, or Glutaraldehyde-Treated Aortic Allografts

Agathe Seguin, MDa,b,*, Dana Radu, MDa,b, Muriel Holder-Espinasse, MD, PhDc, Patrick Bruneval, MDd, Anne Fialaire-Legendre, MDe, Martine Duterque-Coquillaud, PhDc, Alain Carpentier, MD, PhDa,*, Emmanuel Martinod, MD, PhDa,b,*

a Laboratoire de Recherches Biochirurgicales, Fondation Alain Carpentier, Université Paris V, Paris, France
b Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Département de Chirurgie Thoracique et Vasculaire, Université Paris XIII, Faculté de Médecine SMH, Bobigny, France
c Institut de Biologie, Lille, France
d Assistance Publique-Hôpitaux de Paris, Hôpital Européen George Pompidou, Département d'Anatomopathologie, Université Paris V, Faculté de Médecine, Paris, France
e Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, EFS Ile de France, Banque de Tissus, Créteil, France

Accepted for publication November 17, 2008.

* Address correspondence to Dr Seguin, Service de Chirurgie Thoracique et Vasculaire, Hôpital Avicenne, 125 route de Stalingrad, Bobigny Cedex, 93009, France (Email: agathe.seguin{at}avc.aphp.fr).

Background: Seven years of experimental research provided a valuable tracheal substitute, the aortic allograft, which can promote the regeneration of epithelium and cartilage. In human application, both fresh and preserved aortic allografts could be used. The optimal method of aortic allograft preservation remains to be evaluated. This study assessed the use of cryopreserved, decellularized, or glutaraldehyde-treated aortic allografts as tracheal substitutes.

Methods: Twenty-two sheep underwent tracheal replacement using cryopreserved (n = 10), decellularized (n = 7) or glutaraldehyde-treated (n = 5) allografts, supported by a temporary stent to prevent airway collapse. Aortic segments were retrieved at regular intervals up to 12 months after implantation to analyze the regenerative process.

Results: All animals survived the operation. Major complications such as infection, stent migration, or obstruction were predominantly encountered in the decellularized group. The lack of major inflammatory response within the aortic graft observed in the glutaraldehyde group was associated with the absence of tracheal regeneration. Histologic examinations showed a progressive transformation of the aorta into a tracheal tissue comprising respiratory epithelium and cartilage only in the cryopreserved group.

Conclusions: This study demonstrated that regeneration of a functional tissue could be obtained after tracheal replacement with a cryopreserved aortic allograft. The regenerative process followed the same pattern as previously described for fresh allografts. Cryopreserved aortic allografts present major advantages: availability in tissue banks, permanent storage, and no need for immunosuppression. This offers a new field of perspectives for clinical application in patients with extensive tracheal cancer.


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