title: Heterotopic en bloc tracheobronchial transplantation with direct revascularization in pigs.
abstract: 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.
authors.affiliation: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis-Robinson, France. amariliomacedo@terra.com.br
authors.forename: Amarilio
authors.initials: A
authors.lastname: Macedo
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
authors.forename: Guy-Michel
authors.initials: GM
authors.lastname: Mazmanian
authors.forename: Vincent
authors.initials: V
authors.lastname: de Montpréville
authors.forename: Michèle
authors.initials: M
authors.lastname: German-Fattal
authors.forename: Sacha
authors.initials: S
authors.lastname: Mussot
authors.forename: Alain
authors.initials: A
authors.lastname: Chapelier
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Dartevelle
mesh_terms: D000818:Animals; D001980:Bronchi / Q000098:blood supply* / Q000637:transplantation*; D004195:Disease Models, Animal; D006084:Graft Rejection; D006085:Graft Survival; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D013552:Swine; D020858:Tissue and Organ Harvesting; D014132:Trachea / Q000098:blood supply* / Q000637:transplantation*; D014181:Transplantation Immunology; D016042:Transplantation, Heterotopic