ReviewGeneral thoracic and cardiovascular surgery2026
Feasibility and outcomes of long-segment tracheal replacement with biological and engineered scaffolds.
Review in General thoracic and cardiovascular surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo synthesize adult long-segment tracheal replacement using a combined anatomical and graft-based framework and to compare clinically established and investigational strategies with emphasis on mortality, morbidity, airway function, and reintervention.
methodsPubMed/MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure were searched from January 1, 2000, to June 30, 2026. Adult replacements were classified as Type I (upper/cervical), Type II (cervico-mediastinal), Type III (intrathoracic), or Type IV (distal trachea/carina) and by graft class. Forty-three reports comprising 147 extractable patients were synthesized descriptively. The overlapping 50-patient TRITON-01 registry was analyzed separately as the principal cryopreserved aortic-allograft benchmark.
resultsAmong 147 patients, 72 were Type I, 33 Type II, 25 Type III, and 17 Type IV; 113 (76.9%) had malignant disease. Autologous vascularized tissue composites were used in 74 patients (50.3%) and cryopreserved aortic allografts in 52 (35.4%). Overall 30-day and 90-day mortality were 4.8% and 9.5%, respectively. Decannulation was achieved in 103/139 (74.1%); 25.2% required repeat endoscopic intervention and 19.0% developed recurrent stenosis. In the updated 50-patient TRITON-01 registry, 30-day mortality was 4%, major complications 30%, stent-related granuloma 52%, and stent removal 30%. Reliable Type I-IV-specific mortality rates could not be pooled because primary reports did not consistently cross-tabulate outcomes by anatomical level.
conclusionsAnatomy should precede material choice when interpreting tracheal replacement. Autologous vascularized composites have the most mature experience for selected Type I-II reconstruction, whereas Type III-IV intrathoracic and distal/carinal replacement remains more technically hazardous. Cryopreserved aortic allografts provide the current clinical benchmark for biologic full-circumference replacement but require structured stent and bronchoscopic management. Tracheal allotransplantation and engineered or xenogenic constructs remain limited or investigational.
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