Tracheal Replacement by Allogenic Aorta in the Pig: Harvest of the AA

A 10-cm-long segment of the descending thoracic aorta was harvested under general anesthesia through a left thoracotomy in 21 female, large white-landrace piglets weighing 35 to 45 kg. The AAs were placed in isotonic sterile saline solution and transplanted within 2 h of harvesting. Matching of blood and tissue compatibility between recipient and donor was not attempted.
Anesthesia: The animals were premedicated IM with midazolam (5 mg) and ketamine (50 mg). Anesthesia was maintained with a continuous IV infusion of propofol (10 mg/kg/h) and pancuronium (0.3 mg/kg/h). Fentanyl (5 mg/kg/h) was included for analgesia. Postoperative analgesia was provided by a transder-mal patch of fentanyl (50 ^g/h) secured in the inguinal pit before surgery. Prophylactic ceftriaxone was administered IV (500 mg) and IM (500 mg) at induction of anesthesia.
Extrathoracic Tracheal Replacement: The first pigs underwent median cervical incision, and a circular segment (12 to 14 rings) of the extrathoracic trachea was excised, starting at the level of the third or fourth tracheal ring. Cross-field intubation was achieved first with a small (6-mm outer diameter) endotracheal tube introduced in the trachea distal to the excised segment through a short tracheostomy. The AA was interposed, and proximal and distal end-to-end anastomoses were made with a running 4/0 glyconate monofilament suture (Monosyn; Aesculap; Tuttlingen, Germany). The animals were then intubated with an 11-mm outer diameter rigid bronchoscope (Shapsay; Karl Storz; Tuttlingen, Germany). The distal endotracheal tube was then withdrawn, and the short tracheostomy was closed. High-frequency jet ventilation was applied via the bronchoscope. A silicone stent 6 cm in length and 14 mm in diameter (Endoxane; Novatech; Aubagne, France) was then inserted into the lumen of the aortic graft under direct bronchoscopic guidance to prevent airway collapse during inspiration. Partial sternotomy subsequently enabled a longer portion of trachea to be excised (up to 10 cm, representing 18 to 20 rings), followed by bronchoscopic insertion of a longer stent (10 cm). Secondary stent dislodgement in the first animals led us to secure the stent, under broncho-scopic control, to the proximal native trachea, with three absorbable sutures under bronchoscopic control in subsequent animals. Further stent migration led us to fix the stent with three 2/0 nonabsorbable sutures (Dafilon; Aesculap; Tuttlingen, Germany) to the proximal and distal native trachea in the later animals.

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