Tracheal Replacement with Aortic Allografts

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Abstract
We report tracheal replacement with fresh aortic allografts in two patients with large chemotherapy-resistant and radiotherapy-resistant tumors (mucoepidermoid and adenoid cystic carcinomas). These interventions were made on the basis of the extent of the lesions (making them unresectable), the severity of each patient's clinical condition, the lack of alternative treatment options, and the success of this intervention in sheep and pig models.1-4 The transplantation was approved for each patient by the French National Bioethics Advisory Commission. Both procedures were performed through a median cervicosternotomy. In the first patient, tumor dissection was followed by sectioning of the trachea proximally just below the second ring and distally until the cross-section margins were negative for tumor on frozen section (subtotal resection of the main carina). Carinal restitution was achieved by suturing the right and left main bronchi together. An aortic allograft that was harvested from a brain-dead donor and splinted by means of a bifurcated silicone stent was interposed with end-to-end proximal and distal anastomoses ( Figure 1 ). To protect the large vessels from the stent-splinted graft and to promote revascularization, the graft was wrapped with a pectoral muscle flap.

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