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J Thorac Cardiovasc Surg 2004;127:1593-1601
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

Heterotopic en bloc tracheobronchial transplantation with direct revascularization in pigs

^a Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis-Robinson, France
^b Experimental Surgery Laboratory, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis-Robinson, France
^c CNRS-ESA 8078 Laboratory, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis-Robinson, France

Received for publication September 1, 2003; revisions received January 7, 2004; accepted for publication January 27, 2004.

^* Address for reprints: Amarilio Macedo, MD, PhD, Department of Thoracic Surgery and Lung Transplantation, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, 2350, Ramiro Barcellos St, Room 2050, 2nd Floor, 90035-003, Porto Alegre, Brazil
amariliomacedo{at}terra.com.br

OBJECTIVE: This article describes the application of a novel aortic tube technique for directly revascularized tracheobronchial transplantation with dual blood supply in pigs.

METHODS: Eleven adult Large White pigs underwent heterotopic tracheal transplantation with a dual revascularization technique (inferior thyroid artery and bronchial artery). Seven tracheobronchial grafts were perfused ex vivo, and hemodynamic data were collected.

RESULTS: At the last evaluation, 6 pigs had normally epithelialized mucus-producing allografts with correct morphologic conformation and cartilage viability. The histopathologic examination revealed homogeneous tissue regardless of biopsy site (trachea, carina, or bronchi), demonstrating the efficacy of the revascularization procedure. Four animals had early ischemic necrosis develop, 2 from acute rejection and 2 from technical mishap. One additional pig had acute rejection starting on the 14th postoperative day. The CD4⁺/CD8⁺ ratio was maintained close to or above 0.8 in the subgroup with rejection and below 0.6 in the animals that were correctly immunosuppressed. Pressure-flow curves in 7 ex vivo tracheobronchial grafts showed a nonsignificant difference (P < .12) in vascular resistance between the bronchial artery territory (lower resistance) and the inferior thyroid artery territory.

CONCLUSIONS: For the first time, a transplantation technique encompassing the entire trachea, carina, and stem bronchi has been made possible. By means of the dual inferior thyroid and bronchial artery axis, we were able to obtain a structurally healthy and functional graft to replace the main airway.