CHEST Guidelines-Successful-Total-Tracheal-Replacement-by-Cryoprese

Successful-Total-Tracheal-Replacement-by-Cryoprese

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The document reports the first successful total tracheal replacement in a post-COVID-19 patient using a cryopreserved aortic allograft (CAA), completed by a team of doctors including Cecilia Menna and colleagues at Sant’Andrea Hospital, Rome. The patient, a previously healthy 50-year-old man, suffered significant tracheal damage as a result of prolonged intubation and tracheostomy from a severe COVID-19 infection. The extensive damage, including severe stenoses and tracheomalacia, necessitated this innovative surgical intervention.<br /><br />The procedure involved replacing the trachea from the cricoid to the carina, utilizing a cryopreserved aortic graft obtained from a tissue bank. This graft was wrapped in omental tissue and inserted into the tracheal pathway, with a silicon stent ensuring graft patency. Notably, no immunosuppressive therapy was needed, distinguishing this method from other transplant techniques that require such drugs.<br /><br />The patient was extubated successfully on the operating table and was immediately able to breathe, speak, and swallow. After a brief postoperative recovery marked by a minor complication (Pseudomonas aeruginosa pneumonia, resolved with antibiotics), the patient was discharged in excellent health in less than a month. He resumed normal daily activities, including cycling.<br /><br />This case signifies a potentially transformative step in tissue engineering and tracheal surgery, addressing the challenge of tracheal reconstruction without the need for immunosuppression. The successful regeneration of the tracheal tissue supported by the aortic scaffold has broader implications for managing similar cases in the growing population of post-COVID-19 patients facing airway complications. Continued follow-up care for tissue adaptation and stent management remains critical for long-term success.

Keywords

total tracheal replacement

cryopreserved aortic allograft

post-COVID-19 patient

tracheal damage

Sant’Andrea Hospital

tracheomalacia

tissue engineering

tracheal surgery

immunosuppression

airway complications