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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

lingua: Inglese

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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