Experimental Evaluation of Tracheo-Amniotic Shunting for Induced Congenital High Airway Obstruction in a Sheep Model

Abstract

Objective: To evaluate the feasibility of tracheo-amniotic shunting in a sheep model for congenital high airway obstruction syndrome. Material and Methods: High airway obstruction was induced around day 95 (term = 145 days) in 10 lamb fetuses by tracheal clipping. Five days later, ultrasound-guided tracheoamniotic shunting was done using either the Harrison double-pigtail bladder stent (HS) or a double-basket device (BS). Caesarean section (CS) was done around day 110. At each time point, the cardiothoracic index (CTI) was measured. Lung-to-body weight ratio (LBWR) was calculated at fetal necropsy. The primary endpoint was successful shunting defined as anatomically correct placement and functional airway decompression; the secondary endpoint was survival until CS. Results: Two sheep aborted 3 fetuses after tracheal occlusion. Overall, the median CTI at CS was significantly smaller compared to baseline [0.52 (interquartile range, IQR: 0.52-0.54) vs. 0.58 (IQR: 0.54-0.63); p = 0.01]. In the HS group (n = 4), none of the shunts were correctly positioned. In the BS group (n = 3), there was 1 correct shunt placement; however, this fetus was stillborn. Median LBWR suggested pulmonary overgrowth [0.10 (IQR: 0.08-0.11)]. Conclusion: In our hands, using this model with a long and mobile neck and relative oligohydramnios, tracheoamniotic shunting for airway obstruction has a high failure rate. If further pursued, alternative techniques or different models should be considered.