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Original Research: NEOPLASTIC DISEASE |

Tracheal Replacement With Cryopreserved Allogenic Aorta

Demosthènes Makris, MD, PhD; Muriel Holder-Espinasse, MD, PhD; Alain Wurtz, MD; Agathe Seguin, MD; Thomas Hubert, DVM, PhD; Sophie Jaillard, MD, PhD; Marie Christine Copin, MD, PhD; Ramadan Jashari, MD; Martine Duterque-Coquillaud, PhD; Emmanuel Martinod, MD, PhD; Charles-Hugo Marquette, MD, PhD
Author and Funding Information

From the Critical Care Department (Dr Makris), University Hospital Larisa, University of Thessaly, Larisa, Greece; JE2490 Institut de Médecine Prédictive et de Recherche Thérapeutique (Drs Hubert and Marquette), IFR 114 Université de Lille II, Lille, France; UMR8161 CNRS (Drs Holder-Espinasse and Duterque-Coquillaud), Institut de Biologie de Lille, Université Lille Nord de France, Lille, France; Service de Chirurgie Thoracique (Dr Wurtz) and Pôle de Pathologie (Dr Copin), CHRU de Lille, Lille, France; Laboratoire d’Etude des Greffes et Prothèses Cardiaques (Drs Seguin and Martinod), Hôpital Broussais, Université Paris 6, Paris, France; Département de Chirurgie (Dr Jaillard), Polyclinique du Bois, Lille, France; European Homograft Bank (Dr Jashari), Brussels, Belgium; Service de Chirurgie Thoracique et Vasculaire (Dr Martinod), Hôpital Avicenne, Bobigny, France; and INSERM ER1-21 (Dr Marquette), University of Nice Sophia Antipolis, Nice, France.

Correspondence to: Charles-Hugo Marquette, Service de Pneumologie, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, 30 avenue de la voie Romaine, BP 1069, 06002, NICE, cedex 1 France; e-mail: marquette.ch@chu-nice.fr


Funding/Support: This work was supported by the Agence de la Biomédecine (Saint Denis la Plaine, France) and by the RESPIR Foundation (Lille, France).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):60-67. doi:10.1378/chest.09-1275
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Background:  Radical resection of primary tracheal tumors may be challenging when more than one-half of the tracheal length is concerned. The present study evaluated the use of cryopreserved aortic allografts (CAAs) to replace long tracheal segments.

Methods:  Sixteen adult minipigs underwent tracheal replacement with a CAA. A silicone stent was used to splint the CAA for the first 12 months. Animals were followed-up using bronchoscopic evaluation and killed at predetermined times, for a period up to 18 months long.

Results:  Intense inflammation and progressive disappearance of typical histologic structures of the aorta were seen within the first 3 months. All animals studied for more than 3 months showed progressive transformation of the graft into a chimerical conduit sharing aortic and tracheal histologic patterns (eg, islands of disorganized elastic fibers/mature respiratory ciliated epithelium, respiratory glands, islets of cartilage). Stent removal was attempted after 12 months in 10 animals, and critical tracheal stenosis was found in six animals and moderate asymptomatic stenosis in four. Clinical course in these latter animals was uneventful until they were killed at 15 to 18 months. In situ hybridization showed that collagen2a1 mRNA was expressed in the cartilage islets at 1 year. Polymerase chain reaction analysis of the SRY gene demonstrated that the newly formed cartilage cells derived from the host.

Conclusions:  CAA may be considered as a valuable tracheal substitute for patients with extensive tracheal tumors. Prolonged stenting will be probably mandatory for the clinical application of the procedure in humans.

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