Bronchial replacement with arterial allografts.
BACKGROUND
Pneumonectomy is well known for a high risk of postoperative death. The alternative, sleeve lobectomy, is sometimes technically inaccessible, and is associated with locoregional recurrence. In certain situations, the use of a bronchial substitute would allow longer bronchial resections with better security margins. Previous experiments demonstrated that aortic grafts are valuable tracheal and carinal substitutes. The present study evaluated bronchial replacement with arterial allografts.


METHODS
Fifteen female sheep underwent a left bilobectomy with replacement of the bronchus intermedius with arterial allografts: 5 received a fresh graft (group 1) and 10 received cryopreserved (group 2). A bronchial silicone stent was used to confer rigidity. Evaluation was conducted on clinical and histologic criteria at regular intervals up to 18 months.


RESULTS
There were no perioperative deaths. Atelectasis, the only early postoperative complication (n = 2), was successfully treated by fiberscopic aspiration. The late postoperative period was uneventful in 12 sheep. Complications included 1 bronchopneumonia, 1 pulmonary abscess, and 1 distortion of the bronchial stent. Fiberscopic examination revealed 3 sheep with granuloma formation. The bronchial stent was removed in 3 sheep, 1 at 9 months and 2 at 12 months, without clinical complications or stenosis of the graft. Histologic analysis showed regeneration of new bronchial tissue, comprising epithelium and cartilage.


CONCLUSIONS
This study confirmed that an arterial allograft could be a valuable bronchial substitute. The use of a bronchial substitute offers new perspectives in surgical resection of lung cancer because it would avoid pneumonectomy in some patients.
Radu
Dana M
DM
Département de Chirurgie Thoracique et Vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Université Paris XIII, Faculté de Medecine SMBH, Bobigny, France.
Seguin
Agathe
A
Bruneval
Patrick
P
Fialaire Legendre
Anne
A
Carpentier
Alain
A
Martinod
Emmanuel
E
D000818:Animals; D001158:Arteries / Q000637:transplantation*; D001980:Bronchi / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D023421:Models, Animal; D011013:Pneumonectomy / Q000009:adverse effects; D012756:Sheep; D014184:Transplantation, Homologous