# Long-term survival after tracheal replacement using a cryopreserved aortic allograft

Geraud Galvaing, Emmanuel Martinod, Jean-Baptiste Chadeyras

► To cite this version:

Geraud Galvaing, Emmanuel Martinod, Jean-Baptiste Chadeyras. Long-term survival after tracheal replacement using a cryopreserved aortic allograft. JTCVS Techniques, 2024, 28, pp.178 - 179. 10.1016/j.xjtc.2024.08.015. hal-05481846

HAL Id: hal-05481846

https://uca.hal.science/hal-05481846v1

Submitted on 28 Jan 2026

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
# Long-term survival after tracheal replacement using a cryopreserved aortic allograft

Geraud Galvaing, MD,ª Emmanuel Martinod, MD, PhD,ᵇ and Jean-Baptiste Chadeyras, MD,ª
Clermont-Ferrand and Paris, France

<figure><img src="image_2.png" /></figure>

Check for updates

From the ªDepartment of Thoracic and Endocrine Surgery, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; and ᵇDepartment of Thoracic and Vascular Surgery, Chirurgie thoracique et vasculaire, Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, Université Sorbonne Paris Nord, Paris, France.

Ethical statement: Patient's informed consent for publication was obtained. Our institution's ethics committee approved the procedure.

Received for publication May 29, 2024; revisions received Aug 9, 2024; accepted for publication Aug 17, 2024; available ahead of print Aug 28, 2024.

Address for reprints: Geraud Galvaing, MD, Department of Thoracic and Endocrine Surgery, Jean Perrin Comprehensive Cancer Center, 58 rue Montalembert, Clermont-Ferrand, 63000, France (E-mail: geraud.galvaing@clermont.unicancer.fr).

JTCVS Techniques 2024;28:178-9
2666-2507

Copyright © 2024 The Author(s). Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). https://doi.org/10.1016/j.xjtc.2024.08.015

<figure><img src="image_3.png" /><figcaption>Postoperative image highlighting the silicone stent within the aortic allograft (arrow).</figcaption></figure>

Resection of large tracheal segments remains a challenge for thoracic surgeons, particularly when end-to-end anastomosis cannot be performed despite the use of release maneuvers. The feasibility of tracheobronchial replacement using stented aortic matrices has been demonstrated.¹,² We report the case of a patient with prolonged survival after resection of an 8.5-cm tracheal segment, cryopreserved allograft replacement, and subsequent stent removal. Patient's informed consent for publication was obtained. Our institution's ethics committee approved the procedure (IRB 00013468; July 8, 2024).

## CASE REPORT

A 67-year-old man was first admitted to our intensive care unit (ICU) in June 2014 for acute respiratory failure. His medical history included hypertension, atrial fibrillation, and stroke. He had previously undergone a tracheostomy for an unknown reason at another center. During that hospitalization, the tracheostomy was surgically recannulated to facilitate weaning from ventilator support. A diagnosis of compressive left goiter and surrounding tracheomalacia was also made. After 7 days in the ICU, the patient was discharged to a rehabilitation center with a tracheostomy tube but was subsequently lost to follow-up.

During April 2015, the patient was readmitted to our ICU with acute respiratory failure and warfarin overdose. Computed tomography and bronchoscopy confirmed a 4-cm severe stenosis of the trachea, 3-cm distal to the vocal cords, with subsequent tracheomalacia and a known left compressive goiter (Figure 1, A). Due to the extent of the tracheal injury, end-to-end anastomosis was not possible, and the use of a cryopreserved allograft was proposed to the patient and his family. Through a collar incision

associated with a partial sternotomy extended to the second intercostal space, we performed an extensive 8.5-cm tracheal resection and left hemithyroidectomy. A suprathyoid release maneuver allowed a 2-cm reapproximation of the upper trachea. A 5-cm cryopreserved aortic allograft was sewn in an end-to-end fashion using a 4-0 polydioxanone running suture on the membranous/posterior aspect and interrupted sutures on the cartilaginous/anterolateral aspects, and a 7-cm silicone stent (GSS stent; Novatech) was inserted (Figure 1, B). Both the graft and stent had the same diameter of 16 mm, determined based on the patient's tracheal diameter below the stenosis. Sternohyoid muscles were interposed as flaps over the proximal and distal anastomoses. Ventilation was performed via a field tracheotomy over the carina during the procedure, which was sutured before manubrium closure following reintubation through the stent (Figure 2). The patient was rapidly weaned from the ventilator, and his postoperative course was uneventful, without requiring bronchoscopy for sputum aspiration or granulomatous resection. Outpatient follow-up, including computed tomography scans, was initiated.

One year and 5 months later, the stent was easily removed because it interfered with the vocal cords (Figure 1, C). The

## CENTRAL MESSAGE

Cryopreserved aortic allograft is a safe and valuable surgical option as a tracheal substitute. Stent removal is feasible and allows prolonged survival.
<figure><img src="image_4.png" /><figcaption>**FIGURE 1.** Coronal reconstruction of the trachea. A, Preoperative reconstruction showing the tip of the tracheostomy tube above the tracheal stenosis (red arrow) and the left thyroid lobe (white star). B, Postoperative reconstruction highlighting the silicone stent within the cryopreserved allograft (yellow arrow). C, Definitive postoperative view following stent removal, 1 year and 5 months after surgery.</figcaption></figure>

patient lived a normal life, independent at home with his
wife, without respiratory support until his death 5 years
and 7 months after the allograft surgery, nearly 4 years after
stent removal. The cause of death was unknown.

DISCUSSION

Cryopreserved aortic allograft is a reliable, available
tracheal substitute for both malignant and benign conditions
such as extensive tracheobronchial cancer, extensive

<figure><img src="image_5.png" /><figcaption>**FIGURE 2.** Operative view after completing the proximal and distal anastomoses, with the cryopreserved allograft indicated by the *blue arrow*.</figcaption></figure>

thyroid cancer, and complex end-stage postintubation
stenosis. Unlike other techniques,³ its use does not require
multistep surgeries or immunosuppressive treatment,
reducing the risk of postoperative infection. Stent removal
is feasible several months or years after implantation,
with the optimal time based on clinical and bronchoscopic
assessment. De novo generation of pseudocartilage within
the allograft has been demonstrated in vivo.⁴ Further studies
are ongoing to better understand this phenomenon.⁵ Report-
ing this favorable experience with long-term survival is
important as this innovative technique develops. It is impor-
tant to note that the complexity of this procedure requires a
high level of expertise and can only be performed at special-
ized centers.

**Conflict of Interest Statement**

The authors reported no conflicts of interest.

The *Journal* policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

**References**

1. Martinod E, Chouahnia K, Radu DM, et al. Feasibility of bioengineered tracheal and bronchial reconstruction using stented aortic matrices. *JAMA*. 2018;319: 2212-2222.

2. Martinod E, Radu DM, Onorati I, et al. Airway replacement using stented aortic matrices: long-term follow-up and results of the TRITON-01 study in 35 adult patients. *Am J Transplant*. 2022;22:2961-2970.

3. Fabre D, Kolb F, Fadel E, et al. Successful tracheal replacement in humans using autologous tissues: an 8-year experience. *Ann Thorac Surg*. 2013;96:1146-1155.

4. Martinod E, Paquet J, Dutau H, et al. In vivo tissue engineering of human airways. *Ann Thorac Surg*. 2017;103(5):1631-1640.

5. Martinod E, Bensidhoum M, Besnard V, Miyara M, Vicaut E. Confirmation of de novo cartilage generation on aortic matrices after tracheal replacement. *Eur J Cardiothorac Surg*. 2024;65(5):ezae187. https://doi.org/10.1093/ejcts/ezae187