Tracheal allograft replacement *1An unsuccessful method

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Abstract
Replacement of the tracheal conduit remains a difficult and unresolvedsurgical problem. We present an experimental study of 20 pigs undergoingreplacement of the cervical trachea using glutaraldehyde (n = 5), glycerol(n = 5), lyophilized (n = 5) and cryopreserved (n = 5) pretreated allogenicgrafts (AGs). In the lyophilized group, a stainless steel spiralendoprosthesis was used as stent. A segment of native trachea measuring 3.2+/- 0.3 cm (range: 1-5 cm) in length and 1.4 +/- 0.02 cm in diameter wasresected and replaced with AGs measuring 3.8 +/- 0.2 cm in length and 1.4+/- 0.2 cm in diameter. Neither immunosuppressive agents nor steroids weregiven. Animals were followed up with weekly bronchoscopy, and trachea andchest roentgenography. Those receiving glutaraldehyde AG (21.6 +/- 6.4days) and lyophilized AG (19.5 +/- 7.8 days) had a longer survival thanthose receiving glycerol AG (6.8 +/- 0.3 days) and cryopreserved AG (5 +/-0.5 days). At postmortem, grafts were examined grossly and with lightmicroscopy. The cause of death was always airway obstruction, and theunderlying processes were: 1) collapse due to cartilaginous microscopicnecrosis in cryopreserved and glycerol AGs; 2) necrosis of allograft whichcrossed the spiral stent for lyophilized AGs; 3) granulation formation,tissue necrosis and anastomosis leakage in glutaraldehyde AGs. Resultsdemonstrate that passage of necrotic tissue across the grafts represent thecommon failure denominator, making the different AGs studied unsuitable forlong-segment tracheal replacement.

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