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T8. TRACHEAL REPLACEMENT WITH AN AORTIC AUTOGRAFT IN A HUMAN PATIENT
Jacques F. Azorin, Francois J Bertin, Emmanuel Martinod, Francois Vincent, Boris Melloni, Marc J Laskar; BobignyLimoges, France

Objective: Tracheal replacement after extensive resection remains a challenge for thoracic surgery. More than 50 years of research has not provided an ideal synthetic or biologic substitute. We propose an original solution: the use of an aortic autograft. To support this clinical strategy, our first studies were conducted in animal trials. Following success in animals, we report the first successful experience of a long tracheal replacement with an aortic autograft on a human patient.
Methods: For the animal studies, fifty-one sheep were operated in 3 successive trials: replacement of the anterior segment of two tracheal rings (n=10) and tracheal replacement using an aortic autograft (n=21), or allograft (n=20). A tracheal stent was implanted to prevent collapse (n=41). Late post-operative evaluation included clinical bronchoscopy and histological examination with a 3-year follow up.
For the human case we replaced 7cm of a tumoral trachea by an aortic infra-renal autograft harvested during the same operation. The aorta was replaced by a Dacron® tube graft. A special silicone tracheal stent was used to keep the trachea open. There was no local or general extension of the tracheal carcinoma. Prior inform consent and special authorization of the ethics committee was obtained.
Results: For the 46 animals, the late postoperative period was uneventful. Except for mild stenosis in the first animal study, there was no anastomotic leakage or graft rupture. Removal of stents was possible after 6 months. Histological examinations showed a progressive transformation of the aortic graft into tracheal tissue with epithelium and newly formed rings of cartilage.
In our first human case, the postoperative course was marked by granulomas at the proximal anastomosis involving the cricoids and the aorta. This complication necessitated adding an additional tracheal stent. No late postoperative complication were noted following this replacement.
Conclusions: The advantage of the aortic autograft subsitute for the trachea is the resistance to infection and the lack of need for immunosuppression therapy. Large squamous cell carcinoma of the trachea without metastatic extension is unusual. It is known that chemotherapy and radiotherapy alone can´t safely treat this kind of pathology. A new field of clinical study could be pursued, especially in congenital tracheal stenosis. Adenoid cystic tracheal tumors on young adults could also be an excellent indication for this kind of replacement.

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