Martinod E, et al. - Researchers sought to ascertain if airway bioengineering using stented aortic matrices for complex tracheal and bronchial reconstruction is feasible in humans. Findings from this preliminary study suggested human airway bioengineering using stented aortic matrices for tracheal and bronchial reconstruction as feasible.

Methods

• Researchers undertook an uncontrolled single-center cohort study.
• They included 20 patients with end-stage tracheal lesions or with proximal lung tumors requiring a pneumonectomy.
• This study was conducted in Paris, France, from October 2009 through February 2017; final follow-up for all patients occurred on November 2, 2017.
• Using standard surgical techniques, radical resection of the lesions was performed.
• They performed airway reconstruction after resection using a human cryopreserved (-80°C) aortic allograft, which was not matched by the ABO and leukocyte antigen systems.
• They inserted a custom-made stent into the allograft to prevent airway collapse.
• They used the lung-sparing intervention of bronchial transplantation in patients with proximal lung tumors.
• Ninety-day mortality was assessed as the primary outcome.
• Ninety-day morbidity was assessed as the secondary outcome.

Results

• This study included 20 patients (mean age, 54.9 years; age range, 24-79 years; 13 men [65%]).
• In this work, 13 patients underwent tracheal (n=5), bronchial (n=7), or carinal (n=1) transplantation.
• In 7 patients, airway transplantation was not performed because of the following reasons: medical contraindication (n=1), unavoidable pneumonectomy (n=1), exploratory thoracotomy only (n=2), and a lobectomy or bilobectomy was possible (n=3).
• The overall 90-day mortality rate was 5% among the 20 patients initially included(1 patient underwent a carinal transplantation and died).
• Patients who underwent tracheal or bronchial reconstruction exhibited no mortality at 90 days.
• Major 90-day morbidity events occurred in 4 (30.8%) of the 13 patients who underwent airway transplantation; morbidity events included: laryngeal edema, acute lung edema, acute respiratory distress syndrome, and atrial fibrillation.
• No adverse event directly related to the surgical technique was noted.
• At a postoperative mean of 18.2 months, stent removal was performed.
• Ten of the 13 patients (76.9%) were alive at a median follow-up of 3 years 11 months; of these, 8 (80%) breathed normally through newly formed airways after stent removal.
• They observed regeneration of epithelium and de novo generation of cartilage within aortic matrices from recipient cells.