Experimental Carinal Replacement with an Y-Shaped Collagen-Conjugated Prosthesis

Background: A new prosthesis was designed for reconstruction of the bifurcation of the trachea and used for experimental carinal replacement in dogs. Methods: The main Frame of the new prosthesis consists of Y-shaped Marlex mesh tube reinforced with polypropylene spirals. It is coated with collagen extracted from porcine skin to provide biocompatibility and airtightness. Carinal replacement with omentopexy was performed in 17 dogs. Results: Seven dogs survived the postoperative period, and 10 dogs died within 11 days after the operation. The main causes of early postoperative death were fistula and air leakage from the prosthesis. Causes of late postoperative death were obstruction of the main bronchus (two) and lung abscess (one). The four long-term survivors had no stenosis or dehiscence until they were sacrificed 15 months after the operation. Histological examination of these dogs revealed that the luminal surface was covered either with ciliated columnar epithelium or non-ciliated squamous epithelium. Conclusions: The study results suggest the possibility of successful prosthetic carinal reconstruction with epithelial regrowth using this Y-shaped prosthesis.

Key words:

Tracheal prosthesis - Collagen - Carinal reconstruction - Tissue regeneration - Artificial trachea

References

• 1 Grillo H C. Carinal reconstruction.  Ann Thorac Surg.. 1982;  34 356-73
• 2 Pearson F G, Todd T R, Cooper J D. Experience wich primary neoplasms of the trachca and carina.  J Thorac Cardiovasc Surg.. 1984;  88 511-8
• 3 Tsuchiya R, Goya T, Naruke T, Suemasu K J. Resection of tracheal carina for lung cancer.  Thorac Cardiovasc Surg.. 1990;  99 779-87
• 4 Mathisen D J, Grillo H C. Carinal resection for bronchogenic carcinoma.  J Thorac Cardiovasc Surg.. 1991;  102 16-23
• 5 Jacobs J. Investigations into tracheal prosthetic reconstruction.  Laryngoscope.. 1988;  98 1239-45
• 6 Neville W E, Bolanowski P J, Koita G C. Clinical experience with the silicone trachcal prosthesis.  J Thorac Cardiovasc Surg.. 1990;  99 604-13
• 7 Borrie J, Redshow N, Dobbinson T. Silastic tracheal bifurcation prosthesis with subterminal Dacron suture cuffs.  J Thorac Cardiovasc Surg.. 1973;  65 956-62
• 8 Okumura N, Nakamura, Natsume T, Tomihata K, Ikada Y, Shimizu Y. Experimental study on a new tracheal prosthesis made from collagen-conjugated mesh.  J Thorac Cardiovasc Surg.. 1994;  108 337-45
• 9 Teramachi M, Okumura N, Nakamura T. et al . Intrathoracic tracheal reconstruction with a collagen-conjugated prosthesis - evaluation of the efficacy of omental wrapping -.  J Thorac Cardiovasc Surg.. 1997;  113 701-11
• 10 Grillo H C. Circumferential resection and reconstruction of the mediastinal and cervical trachea.  Annals of surgery.. 1965;  162 374-88
• 11 Mulliken J B, Grillo H C. The limits of tracheal resection with primary anastmosis.  J Thorac Cardiovasc Surg.. 1968;  55 418-21
• 12 Theman T E, Kerr J H, Nelems J M, Pearson F G. Carinal resection - A report of two cases and a description of the anesthetic technique.  J Thorac Cardiovasc Surg.. 1976;  71 314-20
• 13 Ishihara T, Ikeda T, Inoue H, Fukai S. Resection of cancer of lung and carina.  J Thorac Cardiovasc Surg.. 1977;  73 936-43
• 14 Mogan E, Lima O, Goldberg M, Ferdman A, Luk S K, Cooper J D. Successful revascularization of totally ischemic bronchial autografts with omental pedicle flaps in dogs.  J Thorac Cardiovasc Surg.. 1982;  84 204-10
• 15 Nakanishi R, Shirakusa T, Takachi T. Omentopexy for tracheal autografts.  Ann Thorac Surg.. 1994;  57 841-5
• 16 Natsume T, Ike O, Okada T, Takimoto N, Shimizu Y, Ikada Y. Porous collagen sponge for esophageal replacement.  J Biomed Mater Res.. 1993;  27 867-75
• 17 Matsubara Y, Kosaba S, Ikeda S. et al . Experimental and clinical results of tracheal prosthesis.  Kyobugeka.. 1990;  43 368-74
• 18 Toomes H, Mickisch G, Vogt-Moykopf I. Experiences with prosthetic reconstruction of the trachea and bifurcation.  Thorax.. 1985;  40 32-7