Feasibility of tissue-engineered tracheal and bronchial reconstruction using an in vivo bioreactor technique.

OBJECTIVE: Reconstruction of long-segment airway defects remains challenging because previous attempts at tissue-engineered airway (TEA) replacement have failed to provide long-term follow-up data. We report the feasibility of a novel in vivo bioreactor technique for TEA reconstruction to correct long-segment tracheal and bronchial defects. METHODS: The outcomes of 7 patients with end-stage tracheal lesions or proximal lung tumors requiring pneumonectomy who underwent radical lesion resection using a standard surgical technique, followed by TEA reconstruction with an in vivo bioreactor technique were retrospectively reviewed. An intramural nitinol stent was inserted between 2 layers of an acellular porcine dermal matrix, with 2 Port-a-Cath (Smiths Medical) catheters connected to a portable peristaltic pump. The TEA was continuously perfused with an antibiotic solution, and peripheral total nucleated cells were harvested and seeded into the implanted TEA substitute twice per week for 2 months. RESULTS: The 7 patients (mean age, 49 years; range, 33-67 years; 4 men) underwent either tracheal (n = 5) or bronchial (n = 2) reconstruction. Two of the 7 patients died within 1 year due to fistula formation between the trachea and brachiocephalic artery. One other major morbidity event (upper anastomosis leakage) was resolved with a longer membrane stent. Three patients died due to tumor relapse (median follow-up, 2 years), whereas 2 patients are still alive (follow-up, 6.5 years). Two patients underwent biopsy-confirmed TEA re-epithelialization. CONCLUSIONS: The findings of this uncontrolled study suggest that TEA using an in vivo bioreactor technique is feasible for long-segment trachea and bronchial reconstruction. Further studies are needed to evaluate efficacy and safety.