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Ann Thorac Surg 2006;81:1068-1074
© 2006 The Society of Thoracic Surgeons

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Original article: General thoracic

Carinal Replacement With an Aortic Allograft

^a Laboratoire d'Etude des Greffes et Prothèses Cardiaques, Hôpital Broussais, Paris, France
^b Service de Chirurgie Thoracique et Vasculaire, Hôpital Avicenne, Paris, France
^c Service d'Anatomo-Pathologie, Hôpital Avicenne, Paris, France
^d Service d'Anatomo-Pathologie, Hôpital Européen George Pompidou, Paris, France

Accepted for publication July 25, 2005.

^_* Address correspondence to Dr Seguin, Laboratoire d'Etude des Greffes et Prothèses Cardiaques, Hôpital Broussais, Pavillon René Leriche, 96, rue Didot, Paris, 75674 Cedex 14 France (Email: agatheseguin{at}wanadoo.fr).

BACKGROUND: Carinal replacement after extensive resection remains a tremendous challenge in thoracic surgery. In previous studies, we demonstrated that an aortic graft could be a valuable tracheal substitute. The goal of this new study was to evaluate the reconstruction of the carina using a stent supported bifurcated aortic allograft.

METHODS: In 15 sheep the replacement of the tracheobronchial bifurcation with an aortic allograft was performed under cardiopulmonary bypass. A temporary stent prevented airway collapse. No immunosuppression was used. Aortic segments were retrieved at regular intervals up to 24 months after implantation.

RESULTS: All animals survived the initial aortic allograft operation. Six animals died postoperatively (1 of graft necrosis, 2 of pneumonia, and 3 of bronchial fistula). The remaining 9 animals were in good condition until they were euthanized. Stent removal was tolerated after 9 months in 3 animals. Progressive transformation of the arterial graft initially into extensive inflammatory tissue, and after 3 to 6 months into a tracheal tissue comprising a well-differentiated epithelium and cartilage was confirmed by histology.

CONCLUSIONS: This study showed that regeneration of a functional tissue can be obtained after replacement of the carina with an aortic allograft. The origin and mechanisms of this regenerative process remains to be discovered. These results represent an important hope for the reconstruction of the carina after extensive resection, especially for cancer lesions. In human application, the systemic use of omentoplasty or myoplasty should further reduce its risk of complication.

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