Reply to Szanto and Molnar About tracheal replacement with an aortic autograft

Tracheal replacement, Aortic autograft, Vascular anastomosis

We would like to thank Dr Tomas Molnar [1] for his comments.

His study on dogs and rabbits uses a ringed vascular prothesis which probably explains the overgrowth of granulation tissue at the junction of the trachea and the prothesis and this, whatever be the technique of anastomosis used.

In our series, the use of an intraluminal silicone stent (Novatech) overlapping the anastomosis has not led to the overgrowth of granulation tissue. Actually, we even fix the silicone stent to lock the trachea and the aortic graft with non-absorbable sutures thus preventing any stent migration.

Concerning the technique used for the trachea-aortic graft anastomosis, we have observed that both structures are approximately of the same diameter and are quite elastic, allowing in all cases, a simple, circular end-to-end anastomosis. We use a continuous large-spaced, tension-free non-ischaemic suture with an absorbable thread.

Finally, we now explain the development of cartilagineous tissue in the neotrachea by the colonization of the aortic graft by host-stem cells with later differentiate into mature cartilagineous rings.

I hope that we have answered your questions.