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France

French medics rebuild windpipes using donor arteries

media Emmanuel Martinod at the Avicenne Hospital in Bobigny, east of Paris, last week AFP

French medics have successfully provided a dozen patients with windpipes made from donor aortas, they told a medical congress in the US on Sunday. Previous attempts, using synthetic replacements, have failed.

"It's not magic but no one really believed it could happen," Professor Emmanuel Martinod, the surgeon who heads the team, said after explaining the reconstructive technique to in the Journal of the American Medical Association (JAMA) and to a medical congress in San Diego, California.

The Paris hospital service also issued a statement about the procedure, which was developed at the Avicenne Hospital just outside the French capital and provided to people whose tracheas had been damaged by cancer or other illnesses.

Since 2009 the medical team has carried out 13 transplants using aortas harvested from the bodies of deceased donors, frozen to -80°C and stored.

Five of them were of tracheas, seven of bronchi and one of a carina, a ridge of cartilage where the trachea divides.

The carina transplant patient died some time after surgery.

The other 12 are all survived at least 90 days and 10 of them were alive after nearly four years.

Eight of them are breathing normally today.

Body's largest artery

Having evolved to channel blood from the heart for a whole lifetime, the aorta, which is the body's largest artery, has thick enough walls to allow it to replace the 10 centimetre-long trachea, which connects the larynx to bronchial tubes feeding into the lungs.

The transplanted blood vessel was supported by stents - tubes inserted to keep the passageway open - which were removed on average about 18 months after surgery.

Previous efforts to completely rebuild the windpipe and airways used artificial tubes seeded with the patient's own stem cells.

But they ended in disgrace for Italian surgeon Paolo Macchiarini, who performed the procedure on eight patients from 2011 to 2014. Seven died from complications and the whereabouts of the eighth is unknown.

It was later revealed that Macchiarini falsified results in published studies.

Unexpected bonuses

In the French team's method, freezing was found to abolish the need for life-long medication to prevent the immune system rejecting the transplanted body parts.

And in follow-ups the replacement aortas were found to regenerate cartilage and epithelium, a thin film that moistens and protects the airways from disease and particles ingested through the mouth.

One of the patients, 40-year-old Eric Volery, would have choked to death due to an acute narrowing of the windpipe, known as tracheal stenosis.

He had been kept alive by a tracheotomy - a hole cut through his throat directly into a less constricted part of his windpipe - and had to put a finger over the hole in order to speak.

Martinod operated on Volery in 2011.

Within a few years, an epithelium had formed and the stent was removed.

"He's in perfect health, and is fond of taking 45 or 50-minute runs," the surgeon told the AFP news agency.

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