Cryopreserved arterial allograft reconstruction after excision of thoracic malignancies.
BACKGROUND
The purpose of this study was to evaluate the long-term clinical and immunologic outcome of cryopreserved arterial allograft (CAA) revascularization of intrathoracic vessels invaded by malignancies.


METHODS
Since January 2002, consecutive patients whose intrathoracic vessels were invaded by malignancies were operated on and revascularizion made using human lymphocyte antigen (HLA)- and ABO-mismatched CAAs. Immunologic studies were performed preoperatively, and 1, 3, 6, 12, and 24 months postoperatively. Postoperative oral anticoagulation therapy was not given.


RESULTS
Twenty-six patients aged 53.1 +/- 15 years with a nonsmall-cell lung cancer (n = 10), invasive mediastinal tumors (n = 7), pulmonary artery sarcoma (n = 3), laryngeal (n = 2), or other rare lung neoplasms (n = 4) underwent operation. Cardiopulmonary bypass was used in 10 cases (38%), and all resections were pathologically complete. Revascularization was either for venous (n = 12) or arterial (n = 14) vessels, and a total of 30 allografts revascularized the superior vena cava (n = 6), pulmonary artery (n = 7), innominate vein (n = 3) or artery (n = 2), ascendent (n = 4) or descending (n = 1) aorta, and subclavian vein (n = 3) or artery (n = 4). Hospital morbidity and mortality were 50% (n = 13) and 3.8% (n = 1), respectively, all CAA unrelated. With a median follow-up of 18 months (range, 3 to 60+), 5-year survival and allograft patency were 84% and 95%, respectively. Preoperative anti-HLA antibodies were detected in 2 patients (7.7%) and a postoperative anti-HLA antibody response, clinically irrelevant, in 1 of 24 patients (4%).


CONCLUSIONS
Revascularization of intrathoracic venous and arterial vessels in patients with malignancies using HLA- and ABO-mismatched CAA is technically feasible and clinically attractive because of no infection risk and postoperative anticoagulation, and excellent long-term survival, patency, and nonimmunogeneicity.
Gómez-Caro
Abel
A
Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Martinez
Elisabeth
E
Rodríguez
Alberto
A
Sanchez
David
D
Martorell
Jaume
J
Gimferrer
Josep Maria
JM
Haverich
Axel
A
Harringer
Wolfgang
W
Pomar
Jose Louis
JL
Macchiarini
Paolo
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D001158:Arteries; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D015925:Cryopreservation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods; D014683:Vena Cava, Superior / Q000473:pathology / Q000601:surgery