title: Repair of large airway defects with bioprosthetic materials.
abstract: Patients with complicated airway defects that exceed the limits of primary repair represent a challenging clinical problem and require alternative techniques for repair. The aim of this study was to evaluate bioprosthetic reconstruction of large tracheal and bronchial defects.
  
  
  
  Retrospective chart review of patients treated at a single tertiary center from 2008 to 2015 who underwent repair of tracheal or bronchial defects with a bioprosthetic device, namely aortic homograft or acellular dermal matrix.
  
  
  
  Eight patients, 3 men and 5 women with a mean age of 54 ± 13 years, underwent closure of complex central airway defects with bioprosthetic material. All but 1 patient underwent prior operative or stenting procedures. Three patients had isolated airway defects, whereas 5 had fistulas between the airway and enteric tract. Defects involved the membranous wall of the trachea (n = 5), the anterior wall of the trachea (n = 1), or the main stem bronchus (n = 2). Five reconstructions were with aortic homograft and 3 with acellular dermal matrix. Bioprosthetic material was buttressed with muscle flap (n = 4), omentum (n = 2), or left unbuttressed (n = 2). The airway defect was successfully closed in all patients. There was no postoperative mortality or recurrence of the airway defect in short-term follow-up. Two patients required debridement of granulation tissue and 1 additional patient required airway balloon dilation. Progression of underlying metastatic disease explained the majority of long-term mortality (75%).
  
  
  
  Bioprosthetic materials represent a viable option for management of large airway defects, including airway-enteric fistulae, that exceed the limits of primary repair.
authors.affiliation: Division of General Surgery, Massachusetts General Hospital, Boston, Mass. Electronic address: budelsman@partners.org.
authors.forename: Brooks V
authors.initials: BV
authors.lastname: Udelsman
authors.affiliation: University of Louisville School of Medicine, Louisville, Ky.
authors.forename: Jessica
authors.initials: J
authors.lastname: Eaton
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass.
authors.forename: Ashok
authors.initials: A
authors.lastname: Muniappan
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Morse
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D062088:Acellular Dermis; D064591:Allografts; D001011:Aorta / Q000637:transplantation*; D001705:Bioprosthesis; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013524:Surgical Flaps; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: acellular dermal matrix; aortic homograft; bioprosthetic; large airway defects