HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cliff K. Choong Joel D. Cooper Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Choong, C. K. Articles by Cooper, J. D. Search for Related Content PubMed PubMed Citation Articles by Choong, C. K. Articles by Cooper, J. D. Related Collections Lung - other

J Thorac Cardiovasc Surg 2005;129:632-638
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Feasibility and safety of airway bypass stent placement and influence of topical mitomycin C on stent patency

Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication April 26, 2004; revisions received July 13, 2004; accepted for publication July 21, 2004.

^* Address for reprints: Joel D. Cooper, MD, Division of Cardiothoracic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 3108 Queeny Tower, St Louis, MO 63110 (E-mail: cooperjd{at}msnotes.wustl.edu).

OBJECTIVE: Airway bypass via transbronchial fenestration has been shown to improve forced expiratory volume and flow in explanted human emphysematous lungs. The aim of this study was to evaluate the feasibility and safety of in vivo airway bypass stent placement by using a canine model and to assess the influence of topical mitomycin C on the prolongation of stent patency.

METHODS: With dogs under general anesthesia, suitable segmental and subsegmental bronchial wall sites were selected by direct visualization with a flexible bronchoscope. Peribronchial blood vessel injury was avoided by using a Doppler probe. Transbronchial fenestration was formed with a 22-gauge transbronchial needle, and the passage was then dilated with a 2.5-mm angioplasty balloon. A balloon expandable stainless-steel stent (3 mm long x 3 mm wide) with a sleeve of silicone rubber covering was placed within the fenestration. Animals were bronchoscoped weekly to assess stent patency. Seventy stents were placed in 12 dogs. Thirty-five served as controls, and the other 35 received transbronchoscopic topical application of mitomycin C once weekly to evaluate the effect on the maintenance of stent patency. Mitomycin C stents were divided into 4 groups according to the number of treatments: group A, 1 treatment only; group B, 4 weeks; group C, 7 weeks; and group D, 9 weeks. Each once-weekly mitomycin C application consisted of 0.2 mL at a concentration of 1 mg/mL, delivered through a small polyethylene catheter.

RESULTS: Four instances of minor and brief bleeding occurred during stent placement and resolved without incident. One pneumothorax occurred and was treated by chest tube placement, without any adverse sequelae. There was no mortality associated with stent placement. No delayed hemorrhage or pneumothorax occurred. All control stents were occluded at the 1-week follow-up. The median durations of stent patency for group A (n = 8), group B (n = 9), group C (n = 10), and group D (n = 8) were 3, 8, 13, and greater than 20 weeks, respectively.

CONCLUSIONS: Airway bypass stent placement can be performed safely. In an animal model, most stents became occluded within 1 week, but topical mitomycin application resulted in significant prolongation of patency.

This article has been cited by other articles:

				C. K. Choong, P. T. Macklem, J. A. Pierce, N. Das, B. A. Lutey, C. O. Martinez, and J. D. Cooper Airway Bypass Improves the Mechanical Properties of Explanted Emphysematous Lungs Am. J. Respir. Crit. Care Med., November 1, 2008; 178(9): 902 - 905. [Abstract] [Full Text] [PDF]

				A. Grgic, H. Wilkens, R. Kubale, A. Groschel, A. Buecker, and G. W. Sybrecht Low-Dose MDCT for Surveillance of Patients with Severe Homogeneous Emphysema After Bronchoscopic Airway Bypass Am. J. Roentgenol., September 1, 2008; 191(3): W112 - W119. [Abstract] [Full Text] [PDF]

				F. Venuta, E. A. Rendina, T. De Giacomo, and G. F. Coloni Bronchoscopic lung volume reduction MMCTS, December 17, 2007; 2007(1217): 2121. [Abstract] [Full Text] [PDF]

				P. F.G. Cardoso, G. I. Snell, P. Hopkins, G. W. Sybrecht, G. Stamatis, A. W. Ng, and P. Eng Clinical application of airway bypass with paclitaxel-eluting stents: Early results. J. Thorac. Cardiovasc. Surg., October 1, 2007; 134(4): 974 - 981. [Abstract] [Full Text] [PDF]

				F. Venuta, E. A. Rendina, T. De Giacomo, M. Anile, D. Diso, C. Andreetti, F. Pugliese, and G. F. Coloni Bronchoscopic procedures for emphysema treatment Eur. J. Cardiothorac. Surg., March 1, 2006; 29(3): 281 - 287. [Abstract] [Full Text] [PDF]

				C. K. Choong, L. Phan, P. Massetti, F. J. Haddad, C. Martinez, E. Roschak, and J. D. Cooper Prolongation of patency of airway bypass stents with use of drug-eluting stents J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 60 - 64. [Abstract] [Full Text] [PDF]