Replacement of a 5-cm Intrathoracic Trachea With a Tissue-Engineered Prosthesis in a Canine Model

BACKGROUND Critical obstacles must be addressed before clinical application of artificial tracheas. The major complications of long tracheal replacement include anastomotic dehiscence and stenosis owing to poor vascularity and incomplete reepithelialization. The objective of this report was to clarify whether preincubation of the prosthesis in the omentum could be applicable for reconstruction of a long segment of the intrathoracic trachea in a canine model. METHODS The framework of an artificial trachea was fabricated from a polypropylene mesh tube and coated with 1% neutral atelocollagen inside and outside the lumen. The prosthesis was placed in the omentum of 9 healthy male beagle dogs for 3 weeks. Then, the pedicled prosthesis was used to replace a 50-mm-long section of intrathoracic trachea. Results were evaluated bronchoscopically, macroscopically, and histologically. RESULTS After 3 weeks of abdominal incubation, the prostheses were incorporated into the host tissue. None of the dogs showed dehiscence of the anastomosis or infection of the prostheses during the postoperative period. Seven of the 9 dogs survived for more than 1 year. One dog died of a bowel obstruction resulting from a diaphragmatic hemia 3 months after replacement, and another died due to reasons unrelated to the prosthesis at 6 months. Bronchoscopic examination revealed no stenosis or dehiscence, and microscopic examination of all dogs showed that the luminal surface was covered by newly regenerated connective tissue and respiratory epithelium. CONCLUSIONS Pedicled omentum-prosthesis complexes may allow successful reconstruction of a long segment of the intrathoracic trachea. (C) 2022 by The Society of Thoracic Surgeons

Automated summary

In a canine model, preincubation of the prosthesis in the omentum was found to be applicable for reconstruction of a long segment of the intrathoracic trachea. After incubation, the prostheses were incorporated into the host tissue, with few postoperative complications.