Sun, Aug 25, 2024 page2

• Hospital repairs tracheal rupture using aortic graft

  • Staff Writer, with CNA
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  A motorcycle rider who was strangled by a power line during a typhoon last year has become the world’s first person to have a traumatic tracheal rupture repaired using an aortic graft, the National Taiwan University Hospital (NTUH) said on Wednesday.

  During Typhoon Koinu in October last year, a 24-year-old man surnamed Tseng (曾) was riding his motorcycle home from work in Yunlin County when the accident happened, NTUH Department of Surgery chairman Chen Jin-shing (陳晉興) said at a news conference.

  After initial treatment at a local hospital, Tseng was transferred to NTUH’s Yunlin Branch, where further complications arose, including serious tracheal stenosis, forcing him to rely on a tracheostomy tube to breathe and a nasogastric tube to eat due to airway blockage, Chen said.

  

  National Taiwan University Hospital physicians pose with a man, sixth left, who had undergone tracheal rupture repair using an aortic graft during a press conference in Taipei on Wednesday.

  Photo: Chiu Chih-jou, Taipei Times

  “Everyone can imagine how difficult it would be for a 24-year-old man to rely on tracheostomy and nasogastric tubes for the rest of his life,” Chen said.

  Tseng was then referred to NTUH in Taipei, where Chen’s team in October last year performed a tracheal reconstruction using an aortic graft from an organ donor.

  The patient recovered well after the surgery, and was off the ventilator the day after the operation and discharged in December, Chen said.

  Tseng had his tracheostomy tube removed in April and has since returned to a normal life, regaining his ability to eat and speak, an NTUH news release said.

  Such kinds of cases are rarely successful, as many patients either pass away at the scene or end up relying on a tracheostomy tube for the rest of their lives, Chen said.

  That surgery was the world’s first instance of repairing a traumatic tracheal rupture using an aortic graft, and the case was accepted for publication last month by JTCVS Techniques, a peer-reviewed journal, he added.

  Regarding the difficulty of performing the reconstruction, Chen said that while short tracheal lesions can be easily managed by resection and reconnection, lesions that are more than 5cm present significant challenges.

  “When the trachea cannot be reconnected due to tumors, stenosis or severe trauma, reconstruction or even transplantation becomes necessary,” he said.

  Tracheal reconstruction or transplantation that involved donated or artificial tracheas has long been a challenging task in pulmonology due to serious transplant rejection, he added.

  Chen and his team, building on the work of French researcher Emmanuel Martinod in 2018, have successfully treated three patients with severe tracheal conditions since 2021 under a human clinical trial program approved by the Ministry of Health and Welfare, the news release said.

  The team used a tissue-engineering technique involving aortic grafts stored at negative 80°C, which were thawed before implantation, and supported by tracheal stents to maintain their shape, eliminating the need for blood type matching and immunosuppressive drugs, it said.

  Asked about the principle of the technique, Chen said that after an aorta is thawed, all the cells die, leaving only a structure similar to that of a trachea, which therefore does not trigger transplant rejection.

  “It [the implanted aortic graft] acts like a bridge or an empty house... As the recipient’s [trachea] cells grow inside of it, they develop into mucosa and cartilage cells, gradually transforming the aorta into a trachea,” he said.
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