The development of a tracheal graft to replace long-segment defects has thwarted clinicians and engineers alike for over 100 years. To better understand the challenges facing this field today, we have consolidated all published reports of engineered tracheal grafts used to repair long-segment circumferential defects in humans, from the first in 1898 to the most recent in 2018, totaling 290 clinical cases. Distinct trends emerge in the types of grafts used over time, including repair using autologous fascia, rigid tubes of various inert materials, and pretreated cadaveric allografts. Our analysis of maximum clinical follow-up, as a proxy for graft performance, revealed that the Leuven protocol has a significantly longer clinical follow-up time than all other methods of airway reconstruction. This method involves transplanting a cadaveric tracheal allograft that is first prevascularized heterotopically in the recipient. We further quantified graft-related causes of mortality, revealing failure modes that have been resolved, and those that remain a hurdle, such as graft mechanics. Finally, we briefly summarize recent preclinical work in tracheal graft development. In conclusion, we synthesized top clinical care priorities and design criteria to inform and inspire collaboration between engineers and clinicians toward the development of a functional tracheal replacement graft.

中文翻译：

---

工程气管置换术的历史：解释过去并指导未来


一百多年来，用于替代长段缺损的气管移植物的开发一直困扰着临床医生和工程师。为了更好地了解该领域当今面临的挑战，我们整合了所有已发表的用于修复人类长段圆周缺陷的工程气管移植物的报告，从 1898 年的第一个到 2018 年的最新报告，总计 290 个临床病例。随着时间的推移，使用的移植物类型出现了明显的趋势，包括使用自体筋膜、各种惰性材料的刚性管和预处理的尸体同种异体移植物进行修复。我们对最大临床随访（作为移植物性能的代表）的分析表明，鲁汶方案的临床随访时间明显长于所有其他气道重建方法。该方法涉及移植尸体气管同种异体移植物，该移植物首先在受体中进行异位预血管化。我们进一步量化了与移植相关的死亡原因，揭示了已解决的失效模式以及仍然存在的障碍，例如移植力学。最后，我们简要总结了最近气管移植物开发的临床前工作。总之，我们综合了临床护理的首要重点和设计标准，以告知和激励工程师和临床医生之间的合作，以开发功能性气管替代移植物。