Tracheal Replacement by Allogenic Aorta in the Pig: Clinical Evaluation

Two of the 14 pigs that underwent replacement of the extrathoracic trachea died within the first week, one from cervicitis due to anastomotic dehiscence and the other immediately after stent dislodgement. Despite fixation with absorbable sutures, the next five pigs also had stent migration and died after 2, 3, 4, 9, and 10 weeks, respectively. Improved fixation of the stent in the following 14 pigs (with nonabsorbable sutures) enabled the stent to splint the malacic graft for a longer period of time, but it still migrated once the sutures had cut the cartilage of the native trachea to which the stent was secured. Migration (n = 3) occurred at 3, 6, and 9 months, respectively. The final two pigs were killed at the predetermined time of 3 months and 12 months, respectively.
Among the seven pigs in which replacement of the intrathoracic trachea was attempted, two died per-operatively. Right empyema developed in one animal that had undergone right pneumonectomy, and this animal had to be killed 2 weeks postoperatively. Another pig that also underwent right pneumonectomy had stent migration after 10 months. The last three pigs that were stented with a Y stent without right pneumonectomy had migration of their stents after 3, 6, and 11 months, respectively.
As a result of the high complication rate from stent migration, relatively few animal made it to a meaningful follow-up period. However, this short follow-up period still allowed us to study the fate of the AA in terms of ischemia or rejection. Additional data regarding epithelial ingrowths and cartilage formation were obtained in the 10 animals and 4 animals that made it to follow-up periods exceeding 3 months and 9 months, respectively. Stent migration was manifested acutely or gradually with intractable cough and dyspnea. Up until that point, clinical evaluation revealed no anastomotic leakage, no dehiscence (with one exception), and no stenosis during follow-up extending to 11 months.

This entry was posted in Allogenic Aorta and tagged airway, lung cancer, transplants.