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J Thorac Cardiovasc Surg 2004;128:638-641
© 2004 The American Association for Thoracic Surgery

Brief communication

First human transplantation of a bioengineered airway tissue

^a Department of Thoracic and Vascular Surgery, Heidehaus Hospital, Medical School Hannover, Hannover, Germany
^b Biothoracic Surgical Laboratory (Leibniz Research Labs for Biotechnology and Artificial Organs [LEBAO]), Medical School Hannover, Hannover, Germany

Received for publication January 18, 2004; revisions received February 8, 2004; accepted for publication February 12, 2004.

^* Address for reprints: Paolo Macchiarini, MD, PhD, Department of Thoracic and Vascular Surgery, Heidehaus Hospital, Hannover Medical School, Am Leineufer 70, D-30419 Hannover, Germany
pmacchiarini@compuserve.com

The first 300 words of the full text of this article appear below.

Airway defects occurring at the anastomotic site after carinal pneumonectomy are associated with persistent contamination between airway and pleural spaces, mediastinal spaces, or both and difficulties in the re-expansion of and possible aspiration into the residual lung. Unfortunately, therapeutic interventions are limited, and the outcome is often fatal.¹ An ideal solution would be to generate an airway segment or surface to be implanted after achieving control of the infection and aspiration. Tissue-engineered airway is about the only technique of the many attempts at tracheal replacement that seems to offer any real promise.² It applies the principles of engineering and life sciences toward the development of biologic substitutes that restore, maintain, or improve tissue function and offers the potential to create replacement structures from biodegradable scaffolds and autologous cells.³ We here describe the first clinical application of a tissue-engineered airway patch.

Clinical summary

A 58-year-old man was admitted in April 2003 complaining of general weakness, coughing up of pus, temperature of greater than 39°C, shortness of breath, and intolerable halitosis. He had undergone a right completion carinal pneumonectomy and radical lymphadenectomy for a relapsing non–small cell lung cancer pathologically staged as T4 N0 M0 in March 2003. He had had an upper bilobectomy and adjuvant radiation therapy (60 Gy) for an non–small cell lung cancer of equal histotype staged as T3 N2 in 1999. On chest radiography, the air-fluid pleural level in the postpneumonectomy space vanished, and the contralateral left lower lobe showed infiltrative signs suggestive of aspiration pneumonitis. Bronchoscopy showed a complete dehiscence of the ventrolateral aspect of the tracheobronchial anastomosis measuring 2 x 2 cm, communicating directly with the residual pleural space. Because Pseudomonas aeruginosa strains were found in the pleural space and blood, the diagnosis of pleural empyema and pyosepticemia was made, and the decision was taken to perform both . . . [Full Text of this Article]