Repair of large airway defects with bioprosthetic materials
- PMID: 27751243
- DOI: 10.1016/j.jtcvs.2016.07.074
Repair of large airway defects with bioprosthetic materials
Abstract
Objective: 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.
Methods: 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.
Results: 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%).
Conclusions: Bioprosthetic materials represent a viable option for management of large airway defects, including airway-enteric fistulae, that exceed the limits of primary repair.
Keywords: acellular dermal matrix; aortic homograft; bioprosthetic; large airway defects.
Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Comment in
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The search for a long-lasting circumferential tracheal conduit: Belsey's problem and ours.J Thorac Cardiovasc Surg. 2016 Nov;152(5):1233-1234. doi: 10.1016/j.jtcvs.2016.08.026. Epub 2016 Aug 29. J Thorac Cardiovasc Surg. 2016. PMID: 27751236 No abstract available.
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Discussion.J Thorac Cardiovasc Surg. 2016 Nov;152(5):1396-1397. doi: 10.1016/j.jtcvs.2016.07.084. J Thorac Cardiovasc Surg. 2016. PMID: 27751244 No abstract available.
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Repair of large airway defects with bioprosthetic materials.J Thorac Dis. 2017 Oct;9(10):3674-3676. doi: 10.21037/jtd.2017.09.104. J Thorac Dis. 2017. PMID: 29268373 Free PMC article. No abstract available.
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