Covid, trachea transplant: the first four cases in the world illustrated

A revolution for the covid emergency and for all those who are intubated or undergo a tracheotomy, sometimes performed in an emergency or for a long time and with possible damage to the patient in the balance between life and death: the trachea transplant is the new frontier of thoracic surgery illustrated on the occasion of the XIV Pneumomeeting in Taormina which brought together 200 doctors and pulmonologist specialists from all over the country. So far only 4 cases in the world, all Italian: patient no. 1, 50 years old from Catania in very serious conditions due to covid and three others (a 48-year-old man and two girls between 20 and 30 years old) with thyroid cancer descended to the trachea, were saved thanks to the innovative technique performed by the team of Erino Rendina, director of thoracic surgery at the Sant’Andrea Sapienza University of Rome, defined as the “craftsman of thoracic surgery”. Rendina, together with the Sicilian patient, was a guest of the Taormina symposium, in which the great novelty was deepened: “Technically it is the replacement of the entire trachea with a frozen tract of aorta – explains Rendina – coming from organ banks. The risks consist in the absolute novelty of such an intervention: there are no previous experiences, 30% was impromptu inventiveness. Patients are fine but have to wait about a year and a half for the aorta to stiffen to allow for near-normal survival. Until now they have to keep a prosthesis: a silicone cylinder that keeps it open and which will then be removed “. There are several critical issues of the NHS that emerged during the three days: “On the covid front, a strong strengthening of local medicine is needed – said Salvatore Privitera, director of the Prevention and Monitoring Center of respiratory insufficiency in Giarre (CT) – with investments aimed at a diagnosis that it is as early as possible to avoid ending up in hospital “. Due to the pandemic, numerous pathologies have been neglected: Carlo Vancheri, Professor of Respiratory Diseases at the Policlinico di Catania and elected president of the Italian Society of Pneumology, spoke about it: “The European data on lack of controls and diagnosis of oncological diseases are alarming. specific field, chronic bronchopneumopathies, pulmonary interstitial diseases and fibrosis, forms of asthma. It will not be easy to make up for a year and a half “. Precisely on asthma, the report by Riccardo Giuliano, outpatient specialist in ASP Pneumology of Catania: “It concerns 300 million people in the world, more than half with risk of exacerbation, with 150/300 thousand deaths per year and very high cost for the NHS . It is necessary to raise awareness on adherence to the therapy attested to 20%; in fact, 70% of asthmatics abandon treatment after three months “. Alberto Terminella, director of UOC Thoracic Surgery of San Marco in Catania, focused on the finding of numerous pathologies such as stenosis and tracheal lesions in patients intubated for covid: “Diseases that we would not have discovered if they had not been hospitalized in intensive care. In this sense, covid has opened up valuable scenarios from a surgical point of view. Pneumomeeting is an opportunity to make PDTAs (diagnostic and therapeutic pathways) operational “. The spotlight is also on sleep problems such as obstructive apnea: “Very widespread in the general population with a strong social impact – highlighted Salvatore Bellofiore, head of the Pulmonary Surgery UOC of Thoracic Surgery of San Marco in Catania – is a risk factor for cardiovascular problems and Alzheimer’s appears to be linked to it. It is necessary to intervene before there is any overt damage, for example thanks to nighttime ventilation in CPAP “. On telemedicine Mario Schisano, pulmonologist former medical director of ASP Syracuse:” It will be one of the future cornerstones of assistance for respiratory diseases, especially for chronic patients or with respiratory insufficiency or neuromuscular diseases that can be remotely controlled. “An innovative technological device was also presented: a sort of” clock “that measures vital parameters for chronic diseases:” The novelty is the detection of blood saturation in all situations of a day of normal daily life – explained Fernando De Benedetto, director emeritus Pneumology of the University of Chieti – when one works, sleeps or takes a shower, while the traditional oximeter with the sensor on the finger measures only a precise and determined moment ; it becomes useful in the initial stages of chronic diseases “.