title: Bronchial replacement with arterial allografts.
abstract: 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.
authors.affiliation: Département de Chirurgie Thoracique et Vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Université Paris XIII, Faculté de Medecine SMBH, Bobigny, France.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Radu
authors.forename: Agathe
authors.initials: A
authors.lastname: Seguin
authors.forename: Patrick
authors.initials: P
authors.lastname: Bruneval
authors.forename: Anne
authors.initials: A
authors.lastname: Fialaire Legendre
authors.forename: Alain
authors.initials: A
authors.lastname: Carpentier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Martinod
mesh_terms: 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