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For The First Time Surgeons Build Windpipes From Arteries


French surgeon Emmanuel Martinod and his team at Avicenne Hospital near Paris have carried out more than a dozen trachea transplants using donor aortas. Where others failed, sometimes spectacularly, French surgeon Emmanuel Martinod has helped people whose windpipes have been ravaged by cancer and other diseases to live and breathe normally again.

At least one of his patients, sporting a new trachea, has taken up long-distance running.
Since 2009, Martinod and his team at Avicenne Hospital near Paris have carried out more than a dozen trachea transplants using donor aortas reinforced with custom-made internal scaffolding, called stents.

Hailed by one US throat surgeon as a “major advance”, the reconstructive technique was detailed in the Journal of the American Medical Association (JAMA), and presented at a medical congress in San Diego, California. Previous efforts to rebuild the windpipe and airways from scratch had focused on using artificial tubes seeded with the patient’s own stem cells.

French surgeon Emmanuel Martinod

Martinod struck on the idea of using aortas from deceased donors to replace damaged sections of the trachea, the roughly 10-centimeter tube of cartilage and tissue that connect the larynx to bronchial tubes feeding into the lungs. The thick walls of aortas are designed to withstand a lifetime of pressure, channeling blood pumped by the heart.

Harvested from donors, the arteries can be frozen to minus 80 degrees Celsius and stored. The freezing process had another huge advantage: it removed the need for a life-long regimen of medications to prevent the immune system from rejecting a transplanted organ.

Follow-ups on the first patients to receive new windpipes brought even more good news. “We went from surprise to surprise because we saw a regeneration of epithelium,” he said.

The inside of a healthy trachea is lined with a thin film, called epithelium, that moistens and protects the airways. It also functions as a barrier to disease and foreign particles transported toward the mouth by tiny, hair-like cilia. Unexpectedly, this crucial layer appeared on the inner surface of the repurposed aortas. New cartilage had also begun to form. “That was the ultimate surprise — aorta transforming itself into a trachea,” said Martinod.
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