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J Thorac Cardiovasc Surg 1997;113:26-036
© 1997 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

OPTIMAL DOSE OF BASIC FIBROBLAST GROWTH FACTOR FOR LONG-SEGMENT ORTHOTOPIC TRACHEAL AUTOGRAFTS

Supported by a grant-in-aid (05771003) from the Ministry of Education, Science, and Culture of Japan.

Received for publication Jan. 4, 1996 Revisions requested March 28, 1996 Revisions received July 9, 1996 Accepted for publication July 10, 1996 Address for reprints: Ryoichi Nakanishi, MD, The Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807, Japan.

Abstract

When a primary anastomosis of the trachea is not feasible, extensive grafting is required. However, despite the use of omental wrapping for revascularization, long-segment tracheal grafts frequently do not maintain structural integrity because of insufficient blood supply. We examined the use of basic fibroblast growth factor for preservation of long-segment tracheal autografts after orthotopic transplantation with omental wrapping in 23 dogs. All animals received orthotopic tracheal transplantation, with 14-ring autografts that occupied a major part of the thoracic trachea, and omental wrapping. The 23 animals were classified randomly into six groups as follows: no treatment (group I, n = 3), topical administration of fibrin glue alone (group II, n = 4), fibrin glue enriched with 1 µg/cm² basic fibroblast growth factor (group III, n = 4), fibrin glue enriched with 5 µg/cm² basic fibroblast growth factor (group IV, n = 4), and fibrin glue enriched with 10 µg/cm² basic fibroblast growth factor (groups V and VI, each n = 4). The omentum that was used to wrap the autografts was fed by the right gastroepiploic artery in groups I to V and by both the right gastroepiploic artery and splenic artery in group VI. All autografts in groups I and II showed dissolution. Ten of 12 autografts in groups III, V, and VI did not maintain long-term structural integrity. By contrast, all autografts in group IV showed long-term viability, as demonstrated by graft patency, epithelialization, cartilage morphology, and vascularity. We conclude that treatment with fibrin glue enriched with 5 µg/cm² basic fibroblast growth factor in combination with omental wrapping may prolong the viability of long-segment tracheal autografts

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