Tracheal Replacement by Allogenic Aorta in the Pig: Intrathoracic Tracheal Replacement

Tracheal Replacement by Allogenic Aorta in the Pig: Intrathoracic Tracheal ReplacementSince experience with the cervical trachea may not necessarily apply to the thoracic portion, we decided to replace the intrathoracic trachea. Pigs invariably have a cranial lobe including bronchus, vein, and artery originating from the right side of the trachea, approximately four to six rings above the main carina. Therefore, resection of the cranial lobe via right thoracotomy had to be performed first. Since ventilation was difficult with this approach, we had to use the right lung for peroperative ventilation. We then replaced the intrathoracic trachea (12 rings) and sutured the distal end of the AA to the left mainstem bronchus. An ā€œLā€ custom-made stent was used to bridge the trachea and the left mainstem bronchus. Right pneumonectomy was then completed.
In a further step, we succeeded in replacing the intrathoracic trachea without right pneumonectomy. After removal of the cranial lobe, the trachea was cut 12 to 14 rings above the carina, and proximal end-to-end anastomosis was achieved while ventilation was ensured via cross-field intubation of the distal trachea. The stent was then introduced cephalad into the distal lumen of the graft, and its upper part was carefully pulled above the upper anastomosis with rigid forceps introduced via the bronchoscope. The distal part of the trachea was then cut one to two rings above the carina. The distal part of the graft and the lower trachea were approximated with a posterior hemicircumferential end-to-end running suture (Monosyn 3/0), while ventilation was ensured through cross-field mainstem endobronchial intubation. The mainstem bronchi were then extubated, and jet ventilation was initiated via the bronchoscope through the Y stent. In order for this to be achieved, the Y stent was gently but quickly pushed caudally with the forceps, while the surgeon helped each leg to enter the left and right mainstem bronchi, respectively. The lateral and anterior parts of the distal anastomosis were then completed around the stent with interrupted sutures. Incisions were closed without thoracic drainage. The animals were extu-bated in the recovery room. No immunosuppressive therapy was administered at any time.

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