NTUH saves man strangled by power line using novel trachea surgery

Taipei, Aug. 21 (CNA) A motorcycle rider strangled by a power line during a typhoon last year has become the world's first person to have a traumatic tracheal rupture repaired using an aortic graft, the National Taiwan University Hospital (NTUH) said Wednesday.

When Typhoon Koinu hit Taiwan in October last year, a 24-year-old man, surnamed Tseng (曾), was riding his motorcycle home from work in Yunlin County when the accident happened, said Chen Jin-shing (陳晉興), chairman of NTUH's Department of Surgery, at a news conference.

After initial treatment at a local hospital, he was transferred to NTUH Yunlin Branch, where further complications, including serious tracheal stenosis, were identified, forcing him to rely on a tracheostomy tube for breathing and a nasogastric tube for feeding due to airway blockage, Chen noted.

"Everyone can imagine how difficult it would be for a 24-year-old young man to rely on a tracheostomy tube and a nasogastric tube for the rest of his life," Chen said, adding that Tseng was then referred to the NTUH in Taipei, where his team performed a tracheal reconstruction surgery using an aortic graft from an organ donor in late October last year.

Tseng recovered well post-surgery, coming off the ventilator the day after the operation and being discharged last December.

By April this year, he had his tracheostomy tube removed and has since returned to a normal life, regaining his ability to eat and speak, according to an NTUH news release.

Chen said that such kinds of cases are rarely successful, as many patients either pass away at the scene or end up relying on a tracheostomy tube for the rest of their lives.

The NTUH team, however, managed to perform the reconstruction, making it the world's first reported instance of repairing a traumatic tracheal rupture using an aortic graft, and the case was accepted for publication in July by JTCVS Techniques, a peer-reviewed journal, he added.

Regarding the difficulty of performing the reconstruction, Chen explained that while short tracheal lesions can be easily managed by resection and reconnection, lesions over 5 centimeters present significant challenges.

"When the trachea cannot be reconnected due to tumors, stenosis, or severe trauma, reconstruction or even transplantation becomes necessary," Chen said.

He added that tracheal reconstruction or transplantation that involved donated or artificial tracheas has long been a challenging task in pulmonology due to serious transplant rejection.

Chen and his team, building on the work of French researcher Emmanuel Martinod in 2018, have successfully treated three patients, including Tseng, with severe tracheal conditions in Taiwan since 2021 under a human clinical trial program approved by the Ministry of Health and Welfare, the news release read.

The team used a tissue-engineering technique involving aortic grafts stored at minus 80 degrees Celsius, which were thawed before implantation, and supported by tracheal stents to maintain their shape, which eliminates the need for blood type matching between donors and recipients and does not require the use of immunosuppressive drugs, the NTUH said.

Asked about the principle of the technique, Chen told CNA that after an aorta is thawed, all the cells die, leaving only a structure similar to that of a trachea, which therefore does not trigger transplant rejection.

"It [the implanted aortic graft] acts like a bridge or an empty house... As the recipient's [trachea] cells grow inside of it, they develop into mucosa and cartilage cells, gradually transforming the aorta into a trachea," Chen explained.