567: Postoperative Critical Care of the First Human Long Segment Orthotopic Tracheal Transplant

Abstract

INTRODUCTION:Airway reconstruction in patients with extensive tracheal defects can be a daunting but life-altering endeavor. Traditionally, airway defects that are less than 5 cm can be bridged with end-to-end anastomoses, while defects that are longer than 5 cm require more extensive reconstruction. Allograft procedures using decellularized and polymeric constructs in human subjects have remained unsuccessful due to lack of mucociliary airway clearance and inadequate blood supply to the transplanted tracheal graft. A first of its kind orthotopic tracheal transplant was performed at Mount Sinai Hospital in a patient with long segment tracheal stenosis using a novel surgical approach. 1 Postoperative critical care management of the patient was vital in ensuring successful integration of the tracheal allograft and maintaining patency of the airway.

Tissue‐engineered tracheal implants: Advancements, challenges, and clinical considerations

“…140 Recent advancements by Delaere et al 141 introduced a twostep procedure, involving the revascularization of the tracheal graft in the patient's forearm before implantation. 142 Although tissue necrosis occurred in some cohort studies, the technology remains promising. 140 Allograft transplantation, providing a structurally sound analogue, exhibits variable success.…”

“…Despite these early achievements, subsequent attempts at trachea transplantation encountered limited clinical success 140 . Recent advancements by Delaere et al 141 introduced a two‐step procedure, involving the revascularization of the tracheal graft in the patient's forearm before implantation 142 . Although tissue necrosis occurred in some cohort studies, the technology remains promising 140 …”