REPLACEMENT OF THYREOTRACHEAL COMPLEX IN PATIENT WITH SUBTOTAL CICATRICAL LESION OF TRACHEA: LONG-TERM RESULTS AND LESSONS LEARNED

Dmitry Bazarov¹, Vladimir Parshin¹, Nikolay Milanov², Margarita Vyjigina³, Michail Rusakov⁴, Evgeny Trofimov², Andrew Volkov¹, Kuldash Abdumuradov¹.

¹Thoracic Division, ²Microsurgery Division, ³Anestesiology Division, ⁴Endoscopic Department, National Research Centre of Surgery, Moscow, Russia.

Background: In majority cases patients with subtotal cicatrical stenosis of trachea doesn’t receive radical surgery both as regarding severity lesion of trachea and advanced comorbidity.

This case report describes a 37-year-old male-patient with complaints to tracheostome with tracheal tube, marked quantity of sputum, severe dyspnoea, productive cough, chest pains.

Chest CT and bronchoscopy revealed cicatrical lesion of trachea spreading from 2 cartilage ring up to last cartilage ring above the carina. In addition on the membrane wall there were several blunt canals to mediastinum. The unique way to help this patient was tracheal replacement. The waiting time of donor was 254 days. Operation was 18/10/2006. Donor was 40 y.o. male dead from severe brain trauma. In our patient cervicotomy with partial sternotomy was performed. Trachea was dissected on level of 1 intercartilage interval and in caudal end left tracheobronchial angle was dissected. Thyreotracheal complex was located in mediastinum and cranial and caudal tracheo-tracheal anastomosis’s were performed by Vicril 2/0. Anastomosis between left and right inferior thyreoid arteries and brachiocephalic artery was performed. In lateral wall of left brachiocephalic vein inferior thyreoid vein of donor was implanted. After beginning of blood flow we noted perfect pulsation of all donor thyreoid vessels and normal color of transplant trachea. In 6 hours after operation patient was extubated.

Results: Patient was discharged with free breathing, without tracheostoma and fever. In 3 years after procedure he had undergone stenting on lower part of donor trachea because of compression from outside probably by donor thyreoid gland. In 4 years after TTR patient breathing well. His immunosupression regimen include cyclosporine A 200 mg/d, methylprednisolone 2 mg/d, mofetyl mycofelonate 2 g/d. He evaluate quality of life as good.

Conclusion: Replacement of trachea with revasculization remains very difficult task of modern thoracic surgery but if performed successfully this procedure might save and improve quality of life of patients with total incurable lesion of trachea.