Novel biodegradable stents in the treatment of bronchial stenosis after lung transplantation

• Published in: European journal of cardio-thoracic surgery 2011-09, Vol.40 (3), p.619-624
• Main Authors: Lischke, Robert, Pozniak, Jiri, Vondrys, David, Elliott, Martin J.
• Format: Article
• Language: English
• Subjects: Absorbable Implants; Adult; Airway Obstruction - etiology; Airway Obstruction - surgery; Anastomosis, Surgical - adverse effects; Biological and medical sciences; Bronchial Diseases - etiology; Bronchial Diseases - surgery; Bronchoscopy; Cardiology. Vascular system; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Epidemiologic Methods; Humans; Lung Transplantation - adverse effects; Medical sciences; Middle Aged; Pneumology; Polydioxanone; Prosthesis Design; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2010.12.047

Abstract Objective: To evaluate the safety and effectiveness of novel biodegradable (BD) stents to treat bronchial anastomotic stenosis in patients after lung transplantation. Methods: Twenty BD stents were implanted endoscopically in six patients (median age 41.5 years (range 35-57 years)) with post-transplant bronchial anastomotic stenoses, between 2006 and 2010. All stents were custom-made from bio-absorbable polydioxanone (PDS). The median stent diameter was 12 mm (8-17 mm) and median length was 20 mm (12-30 mm). All patients were evaluated clinically, by bronchoscopy and high-definition computed tomography (CT). Results: The stenosis was initially relieved in all cases. There was no bleeding, perforation or displacement after BD stent implantation. Four patients needed multiple stenting for anastomotic re-stenosis. Median time to any re-stenting was 5 months (2-15 months). There was one sudden death, 1 year after the last BD stent implantation, from a pulmonary embolus. All five survivors are in good clinical condition up to 4 years' follow-up (median 40 months, range 7-48 months) since first stenting and intervention-free up to 44 months (median 24 months, range 7-44 months). Conclusions: This small pilot study shows that BD stents are a safe, effective and reliable alternative to classical metallic stents in patients with anastomotic stenosis after lung transplantation, and may avoid the need for permanent stenting.