Tracheal Replacement With a Silicone-Stented, Fresh Aortic Allograft in Sheep Hisashi Tsukada, MD, PhD, Armin Ernst, MD, Sidhu Gangadharan, MD, Simon.

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Presentation transcript:

Tracheal Replacement With a Silicone-Stented, Fresh Aortic Allograft in Sheep Hisashi Tsukada, MD, PhD, Armin Ernst, MD, Sidhu Gangadharan, MD, Simon Ashiku, MD, Robert Garland, RTT, Diana Litmanovich, MD, Malcolm DeCamp, MD The Annals of Thoracic Surgery Volume 89, Issue 1, Pages 253-258 (January 2010) DOI: 10.1016/j.athoracsur.2009.09.005 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Sheep #3 at 3 months. (A) Computed tomography revealed distal airway migration of a silicone stent. (B) The migrated stent with graft was removed by rigid bronchoscope. The Annals of Thoracic Surgery 2010 89, 253-258DOI: (10.1016/j.athoracsur.2009.09.005) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Parallel bronchoscopic (left) and computed tomography (right) images in sheep 10. (A) Yellowish-white aortic graft was seen through the stent and computed tomography revealed thick reactive tissue surrounding the stent at 2 weeks after surgery. (B) Partial aortic graft defect was seen and hypervascular reaction tissue was observed at 2 months. (C) Aortic graft invisible and grafted area was replaced with connective tissue at 1 year. The Annals of Thoracic Surgery 2010 89, 253-258DOI: (10.1016/j.athoracsur.2009.09.005) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Bronchoscopic findings of sheep 8 at 1 month after surgery. (A) Yellowish-white specimen was observed at the end of the silicone stent. (B) Same specimen confirmed as necrotic aorta with calcification (hematoxylin and eosin; original magnification, ×100). The Annals of Thoracic Surgery 2010 89, 253-258DOI: (10.1016/j.athoracsur.2009.09.005) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Computed tomography traced metal marker in sheep 10 at 2 weeks (A) and 1 year (B). Distal native trachea shifted up toward the proximal; no neocartilage ring was detected at grafted area. The Annals of Thoracic Surgery 2010 89, 253-258DOI: (10.1016/j.athoracsur.2009.09.005) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Gross morphology of a harvested specimen in sheep 7 at 6 months. (A) Suture materials were confirmed at the both ends of native trachea. (B) Grafted area length was 1.5 cm in diameter. (C) No evidence of neocartilage formation between proximal and distal native tracheal cartilage ring. The Annals of Thoracic Surgery 2010 89, 253-258DOI: (10.1016/j.athoracsur.2009.09.005) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Necrotic aortic graft without any incorporation into surrounding tissue at 12 days after tracheal replacement (hematoxylin and eosin; original magnification, ×50; from sheep 1). The Annals of Thoracic Surgery 2010 89, 253-258DOI: (10.1016/j.athoracsur.2009.09.005) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Graft harvested from sheep 10 at 1 year after tracheal replacement (original magnification, ×6). (A) Mucociliary epithelialization was observed at the grafted area without signs of neocartilage formation (hematoxylin and eosin staining). (B) Safranin-O stains were strongly positive only at the native tracheal cartilage. The Annals of Thoracic Surgery 2010 89, 253-258DOI: (10.1016/j.athoracsur.2009.09.005) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 Mucociliary epithelium was confirmed on the fibrous connective tissue at grafted area on 1 year after the surgery (hematoxylin and eosin; original magnification, ×630; from sheep 2). The Annals of Thoracic Surgery 2010 89, 253-258DOI: (10.1016/j.athoracsur.2009.09.005) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions