Download PDF
CC BY 4.0 · Surg J (N Y) 2024; 10(04): e43-e52
DOI: 10.1055/s-0044-1792126
Original Article

Tracheal Replacement: A Scoping Review

Darin T. Johnston
1   Uniformed Services University, Craniomaxillofacial Trauma & Reconstruction, Oral & Maxillofacial Surgery, David Grant Medical Center, Travis AFB, California
2   Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
,
David B. Powers 
2   Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
,
Matthew G. Hartwig
3   Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
,
Russel R. Kahmke
4   Department of Head and Neck Surgery and Communication Sciences, Duke University Hospital, Durham, North Carolina
,
Linda C. Cendales
2   Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective To summarize patient characteristics and outcomes for the historical and current methods of long-segment tracheal replacement in humans.

Materials and Methods A single reviewer screened the abstracts and full texts using Covidence for file management. Studies published in English that reported human subjects with circumferential or near-circumferential (>270 degrees) cervical tracheal replacements were included. Articles with subjects treated with primary anastomosis alone, retracted articles, abstracts, expert opinion articles, and conference presentations were excluded.

Results A total of 32 articles were included in the review reporting 156 cases of long-segment tracheal replacement including synthetic (alive at 1–8 years n = 6/64), regenerative medicine (dead at 15 days–55 months n = 4, not reported n = 6), cadaveric tracheal allograft (alive at 5 months–10 years n = 32/38), aortic allograft (alive at 6–85 months n = 12/16), free tissue transfer (alive at 6–108 months n = 13/21), allotransplantation (alive at 6–24 months n = 5/8), and vascular composite allograft (VCA) (alive at 20 months n = 1/1).

Conclusion Silicone and Marlex prostheses have poor long-term outcomes. The cadaveric tracheal allograft can only replace near-circumferential tracheal defects and is therefore limited to benign tracheal pathology. Inadequate structural support plagues the aortic allograft and often requires numerous invasive procedures and maintenance of an intraluminal stent. A lack of mucociliary clearance exists in all methods of tracheal replacement except cadaveric tracheal allograft and VCA and can cause fatal mucous plugging and chronic pulmonary infections. VCA and allotransplantation require long-term immunomodulation therapy.

Keywords

microvascular - reconstruction - transplant - surgery - airway stenosis - trachea


Publication History

Received: 06 August 2024

Accepted: 07 October 2024

Article published online:
12 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Neville WE, Bolanowski PJ, Soltanzadeh H. Homograft replacement of the trachea using immunosuppression. J Thorac Cardiovasc Surg 1976; 72 (04) 596-601
    CrossrefPubMedSearch in Google Scholar
  • 2 Olmedo G, Rosenberg M, Fonseca R. Primary tumors of the trachea. Clinicopathologic features and surgical results. Chest 1982; 81 (06) 701-706
    CrossrefPubMedSearch in Google Scholar
  • 3 Toomes H, Mickisch G, Vogt-Moykopf I. Experiences with prosthetic reconstruction of the trachea and bifurcation. Thorax 1985; 40 (01) 32-37
    CrossrefPubMedSearch in Google Scholar
  • 4 Maziak DE, Todd TR, Keshavjee SH, Winton TL, Van Nostrand P, Pearson FG. Adenoid cystic carcinoma of the airway: thirty-two-year experience. J Thorac Cardiovasc Surg 1996; 112 (06) 1522-1531 , discussion 1531–1532
    CrossrefPubMedSearch in Google Scholar
  • 5 Azorin JF, Bertin F, Martinod E, Laskar M. Tracheal replacement with an aortic autograft. Eur J Cardiothorac Surg 2006; 29 (02) 261-263
    CrossrefPubMedSearch in Google Scholar
  • 6 Davidson MB, Mustafa K, Girdwood RW. Tracheal replacement with an aortic homograft. Ann Thorac Surg 2009; 88 (03) 1006-1008
    CrossrefPubMedSearch in Google Scholar
  • 7 Martinod E, Chouahnia K, Radu DM. et al. Feasibility of bioengineered tracheal and bronchial reconstruction using stented aortic matrices. JAMA 2018; 319 (21) 2212-2222
    CrossrefPubMedSearch in Google Scholar
  • 8 Menna C, Andreetti C, Ibrahim M. et al. Successful total tracheal replacement by cryopreserved aortic allograft in a patient post-COVID-19 infection. Chest 2021; 160 (06) e613-e617
    CrossrefPubMedSearch in Google Scholar
  • 9 Wurtz A, Porte H, Conti M. et al. Surgical technique and results of tracheal and carinal replacement with aortic allografts for salivary gland-type carcinoma. J Thorac Cardiovasc Surg 2010; 140 (02) 387-393.e2
    CrossrefPubMedSearch in Google Scholar
  • 10 Propst EJ, Prager JD, Meinzen-Derr J, Clark SL, Cotton RT, Rutter MJ. Pediatric tracheal reconstruction using cadaveric homograft. Arch Otolaryngol Head Neck Surg 2011; 137 (06) 583-590
    CrossrefPubMedSearch in Google Scholar
  • 11 Jacobs JP, Elliott MJ, Haw MP, Bailey CM, Herberhold C. Pediatric tracheal homograft reconstruction: a novel approach to complex tracheal stenoses in children. J Thorac Cardiovasc Surg 1996; 112 (06) 1549-1558 , discussion 1559–1560
    CrossrefPubMedSearch in Google Scholar
  • 12 Kunachak S, Kulapaditharom B, Vajaradul Y, Rochanawutanon M. Cryopreserved, irradiated tracheal homograft transplantation for laryngotracheal reconstruction in human beings. Otolaryngol Head Neck Surg 2000; 122 (06) 911-916
    PubMedSearch in Google Scholar
  • 13 Yu P, Clayman GL, Walsh GL. Human tracheal reconstruction with a composite radial forearm free flap and prosthesis. Ann Thorac Surg 2006; 81 (02) 714-716
    CrossrefPubMedSearch in Google Scholar
  • 14 Maciejewski A, Szymczyk C, Półtorak S, Grajek M. Tracheal reconstruction with the use of radial forearm free flap combined with biodegradative mesh suspension. Ann Thorac Surg 2009; 87 (02) 608-610
    CrossrefPubMedSearch in Google Scholar
  • 15 Fabre D, Kolb F, Fadel E. et al. Successful tracheal replacement in humans using autologous tissues: an 8-year experience. Ann Thorac Surg 2013; 96 (04) 1146-1155
    CrossrefPubMedSearch in Google Scholar
  • 16 Thomet C, Modarressi A, Rüegg EM, Dulguerov P, Pittet-Cuénod B. Long-segment tracheal reconstruction with free radial forearm flap reinforced by rib cartilage. Ann Plast Surg 2018; 80 (05) 525-528
    CrossrefPubMedSearch in Google Scholar
  • 17 Olias J, Millán G, da Costa D. Circumferential tracheal reconstruction for the functional treatment of airway compromise. Laryngoscope 2005; 115 (01) 159-161
    CrossrefPubMedSearch in Google Scholar
  • 18 Beldholm BR, Wilson MK, Gallagher RM, Caminer D, King MJ, Glanville A. Reconstruction of the trachea with a tubed radial forearm free flap. J Thorac Cardiovasc Surg 2003; 126 (02) 545-550
    CrossrefPubMedSearch in Google Scholar
  • 19 Delaere P, Vranckx J, Verleden G, De Leyn P, Van Raemdonck D. Leuven Tracheal Transplant Group. Tracheal allotransplantation after withdrawal of immunosuppressive therapy. N Engl J Med 2010; 362 (02) 138-145
    CrossrefPubMedSearch in Google Scholar
  • 20 Xu L, Zhang S, Li J. et al. Human tracheal allotransplant with greater omentum for revascularization. Exp Clin Transplant 2014; 12 (05) 448-453
    PubMedSearch in Google Scholar
  • 21 Genden EM, Miles BA, Harkin TJ. et al. Single-stage long-segment tracheal transplantation. Am J Transplant 2021; 21 (10) 3421-3427
    CrossrefPubMedSearch in Google Scholar
  • 22 Fux T, Österholm C, Themudo R, Simonson O, Grinnemo KH, Corbascio M. Synthetic tracheal grafts seeded with bone marrow cells fail to generate functional tracheae: first long-term follow-up study. J Thorac Cardiovasc Surg 2020; 159 (06) 2525-2537.e23
    CrossrefPubMedSearch in Google Scholar
  • 23 Elliott MJ, Butler CR, Varanou-Jenkins A. et al. Tracheal replacement therapy with a stem cell-seeded graft: lessons from compassionate use application of a GMP-compliant tissue-engineered medicine. Stem Cells Transl Med 2017; 6 (06) 1458-1464
    CrossrefPubMedSearch in Google Scholar
  • 24 Elliott MJ, De Coppi P, Speggiorin S. et al. Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study. Lancet 2012; 380 (9846) 994-1000
    CrossrefPubMedSearch in Google Scholar
  • 25 Kanemaru S, Hirano S, Umeda H. et al. A tissue-engineering approach for stenosis of the trachea and/or cricoid. Acta Otolaryngol Suppl 2010; (563) 79-83
    PubMedSearch in Google Scholar
  • 26 Delaere PR, Vranckx JJ, Den Hondt M. Leuven Tracheal Transplant Group. Tracheal allograft after withdrawal of immunosuppressive therapy. N Engl J Med 2014; 370 (16) 1568-1570
    CrossrefPubMedSearch in Google Scholar
  • 27 Martinod E, Paquet J, Dutau H. et al. In vivo tissue engineering of human airways. Ann Thorac Surg 2017; 103 (05) 1631-1640
    CrossrefPubMedSearch in Google Scholar
  • 28 Fabre D, Fadel E, Mussot S. et al. Autologous tracheal replacement for cancer. Chin Clin Oncol 2015; 4 (04) 46
    PubMedSearch in Google Scholar
  • 29 Zhang S, Liu Z. Airway reconstruction with autologous pulmonary tissue flap and an elastic metallic stent. World J Surg 2015; 39 (08) 1981-1985
    CrossrefPubMedSearch in Google Scholar
  • 30 Hamilton NJ, Kanani M, Roebuck DJ. et al. Tissue-engineered tracheal replacement in a child: a 4 year follow-up study. Am J Transplant 2015; 15 (10) 2750-2757
    CrossrefPubMedSearch in Google Scholar
  • 31 Kanemaru S, Hirano S, Umeda H. et al. A tissue-engineering approach for stenosis of the trachea and/or cricoid. Acta Otolaryngol Suppl 2010; (563) 79-83
    CrossrefPubMedSearch in Google Scholar
  • 32 Kunachak S, Vajaradul Y, Rerkamnuaychok B, Praneetvatakul V, Rochanawutanon M. Fate of mucosal healing in transplanted deep frozen irradiated tracheal homograft. Otolaryngol Head Neck Surg 2007; 136 (06) 1010-1013
    CrossrefPubMedSearch in Google Scholar
  • 33 Delaere PR, Vranckx JJ, Meulemans J. et al. Learning curve in tracheal allotransplantation. Am J Transplant 2012; 12 (09) 2538-2545
    CrossrefPubMedSearch in Google Scholar
  • 34 Chopra A, Oropello JM, Wang J, Mo E, Kohli-Seth R, Genden EM. Critical care and postoperative management of the first human long segment orthotopic tracheal transplantation. Crit Care Explor 2022; 4 (12) e0809
    PubMedSearch in Google Scholar
  • 35 Genden E, Harkin T, Laitman B, Florman S. Vascularized tracheal transplantation: a twenty month follow up. Laryngoscope 2022; 00: 1-7
    CrossrefPubMedSearch in Google Scholar
  • 36 Etienne H, Fabre D, Gomez Caro A. et al. Tracheal replacement. Eur Respir J 2018; 51 (02) 51
    CrossrefPubMedSearch in Google Scholar
  • 37 Genden EM, Gannon PJ, Smith S, Keck N, Deftereos M, Urken ML. Microvascular transfer of long tracheal autograft segments in the canine model. Laryngoscope 2002; 112 (03) 439-444
    CrossrefPubMedSearch in Google Scholar
  • 38 Genden EM, Gannon PJ, Smith S, Deftereos M, Urken ML. Microvascular transplantation of tracheal allografts model in the canine. Ann Otol Rhinol Laryngol 2003; 112 (04) 307-313
    CrossrefPubMedSearch in Google Scholar
  • 39 Henderson ML. The landscape of vascularized composite allograft donation in the United States. Curr Opin Organ Transplant 2019; 24 (06) 699-704
    CrossrefPubMedSearch in Google Scholar