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Ann Thorac Surg 2004;78:1133
© 2004 The Society of Thoracic Surgeons

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Correspondence

Replacement of the trachea with an autologous aortic graft: Reply

Service de Chirurgie Thoracique et Vasculaire, Hôpital Avicenne, 125 Route de Stalingrad, 93000 Bobigny, France

Alain F. Carpentier, MD, PhD

Laboratoire d'Etude des Greffes et Prothèses Cardiaques, Hôpital Broussais, UPRES 264, Université Paris 6, 96 Rue Didot75014 Paris, France

emartinod{at}wanadoo.fr

To the Editor:

We thank Drs Mertsching and associates for their interest in our work on tracheal replacement using an autologous aortic graft and particularly for pointing out that the results of our study raise many intriguing questions about the regeneration of tracheal tissue from an aortic graft [1]. We understand their reluctance to believe what we ourselves observed with great surprise. However, when scientific findings are stubbornly duplicated in repeated, carefully conducted experimentation, it is hard not to believe them. We will clarify some points. First, we did not say that the inflammatory process was linked to the presence of a stent. Rather, we found that the inflammation of the transplanted aortic segment was less important in the group with the silicone stent and that we obtained a complete regeneration of a mucociliary epithelium after removal of the stent. Second, there is no question that a certain degree of ischemia of the aortic graft may play a role in triggering the tissue transformation. However, it did not lead to a degenerative process but to a reconstructive process, which had not been observed until then. We think that this initial process of inflammation could have created favorable conditions for tracheal regeneration, as it has previously been observed with other tissues such as the liver [2]. We also stressed how "mysterious" the appearance of newly formed cartilage is, and this leads to hypotheses that should be investigated. Third, we have not found it necessary to quantify collagen II in the extracellular matrix because it is well known that collagen II is a major component of newly formed cartilage. We will certainly continue our investigation to try to clarify the mechanisms involved in this transformation. Fourth, the fact that previous work on guided tissue regeneration and tissue engineering has been associated with disappointing results up to now does not mean that with improved techniques and perseverance, they will not succeed 1 day. In any case, our approach has been quite different.

Finally, we thank the discussants for the usual ethical recommendation concerning the clinical application of a new technique. This was superfluous, as we have not yet tried the method in a clinical setting. However, we have now a 3-year follow-up with no complications in 14 sheep, and Hazekamp and Nijdam [3] have used aortic tissue to patch a long tracheal stenosis in 2 newborns and an autologous carotid artery patch in a 4-month-old girl; the results have been encouraging.

References

1. Martinod E, Seguin A, Pfeuty K, et al. Long-term evaluation of the replacement of the trachea with an autologous aortic graft. Ann Thorac Surg. 2003;75:1572–1578[Abstract/Free Full Text]
2. Libbrecht L, Desmet V, Van Damme B, Roskams T. Deep intralobular extension of human hepatic ‘progenitor cells' correlates with parenchymal inflammation in chronic viral hepatitis: can ‘progenitor cells' migrate? J Pathol. 2000;192:373–378[Medline]
3. Hazekamp MG, Nijdam N. Use of autologous arterial patches for tracheal reconstruction in young infants [Letter]. Ann Thorac Surg 2004;7:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Emmanuel Martinod Alain F. Carpentier Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Martinod, E. Articles by Carpentier, A. F. Search for Related Content PubMed Articles by Martinod, E. Articles by Carpentier, A. F. Related Collections Trachea and bronchi Related Article