D24-08 “Trumpet” 3D Stents for Left Anastomotic Complications After Lung Transplantation: A Case Series

Abstract Introduction Left anastomotic complications remain a significant challenge following lung transplantation, especially when they occur close to the secondary carina. Personalized 3D-engineered devices have been developed to reduce the complications rate of airway stenting in non-malignant stenoses. However, if the rationale behind the use of 3D stents to prevent granulation tissue reaction and migration is clear, it is less clear whether it can decrease the risk or mucus plugging, which is probably much more linked to the total surface covered and the number and diameter(s) of branches of the stent. We aimed to analyze a subpopulation of patients treated with a personalized stent designed to enter both lower and upper left lobes, without bifurcation, mimicking a “trumpet” shape Methods and description of the cases Computer-assisted modelling of the airways is performed from a fully inspired CT scan to virtually correct the anomaly. Virtual stents are designed (AnatomikModelingTM, France, Figure D-G). Data are then entered in a 3D printer to manufacture the mold, in which medical-grade silicone is injected to manufacture the stent (NovatechTM, Germany). The thickness of the stent is set to 1.2 to 1.5 mm, based on previous experience of the radial force needed. Four consecutive patients with symptomatic left anastomotic stenoses for whom standard or bifurcated 3D silicone stents failed (severe complications, including mucus plugging) were (n = 2) or are planned (n = 2) to be treated using these “trumpet”-like 3D stent. Results and discussion of the novelty and importance of the cases The placement was successful in the 2 cases performed, showing very good congruence with the airways (Figure A-C). Post-implantation, these 2 patients experienced significant improvement in airway patency as confirmed by bronchoscopy and imaging. No immediate or delayed procedure-related complications were observed, particularly airway plugging, over a follow-up period ranging from 6 to 18 months. Immediate and 3 months follow-up will be available for all 4 patients at the time of the meeting. This case series highlight the feasibility and effectiveness of simplified design for the treatment of left anastomotic complications in lung transplant recipients that should favor mucus clearance. The message is of importance since physicians tend to design highly complex stents when considering personalized devices, exposing patients to the risk of mucus plugging. This sub-population of patients will be further analyzed in the ETNA randomized trial to be launched in which 3D and standard silicone stents will be compared. This abstract is funded by: Novatech partially funded the TATUM trial in which 3/4 patients were included