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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1999 August;40(4):591-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Successful tracheocarinal transplantation

Nakanishi R., Hashimoto M, So T., Sugaya M., Yasumoto K.

From the Second Department of Surgery School of Medicine University of Occupational and Environmental Health Kitakyushu, Japan


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Background. When exten­sive por­tions of the tra­chea and cari­na are resect­ed, graft­ing is ­required.
Methods. Two experi­ments ­were per­formed in ­dogs to ­assess the fea­sibil­ity of exten­sive tra­che­o­car­i­nal replace­ment ­using ­short-seg­ment tra­che­o­car­i­nal auto­grafts, ­only to ­avoid the immu­no­log­ic com­plex­ity of allo­grafts. To deter­mine the ­effect of ten­sion on ­graft sur­vi­val, exten­sive tra­cheal ­defects (12 to 18 ­rings) ­were crea­ted in ­four ani­mals. These ­were sub­seq­uendy recon­struct­ed ­using 6-­ring auto­grafts. In the sec­ond experi­ment, ­three ani­mals under­went exci­sion of a max­i­mal ­length of tra­chea deter­mined in experi­ment 1 includ­ing the cari­na. Long-­term viabil­ity of ­each ­graft was ­assessed ­using bron­chos­co­py and his­to­log­ic exam­ina­tion.
Results. The lim­it of tra­cheal resec­tion suc­cess­ful­ly recon­struct­ed ­using a 6-­ring auto­graft was 14 ­rings (experi­ment 1). The tra­cheal ­grafts in ­which the ten­sion was great­er ­than 1.2 kg did not main­tain ­their struc­tu­ral integ­rity. All of the auto­grafts in experi­ment 2 ­were sub­ject­ed to a ten­sion of ­less ­than 1.0 kg at the anas­to­mos­es, and ­showed ­long-­term viabil­ity.
Conclusions. We con­clude ­that exten­sive tra­cheal and car­i­nal ­defects may be suc­cess­ful­ly recon­struct­ed ­using ­short-seg­ment tra­che­o­car­i­nal ­grafts if the anas­to­mos­es are sub­ject­ed to ­less ­than 1.0 kg of ten­sion.

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