Tracheostomy After Operations for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

摘要

Audio/VideoDownload File (109.54 MB)Download File (109.54 MB)Need help playing this video?Try playing the flash (.flv) version of this videoYou may need to download the latest version of FlashUse the "Download File" link to play the source videoAuthor InterviewData SourceStudy PopulationData Collection and DefinitionsStatistical AnalysisSupplementary DataReferencesInformation concerning tracheostomy after operations for congenital heart disease has come primarily from single-center reports. We aimed to describe the epidemiology and outcomes associated with postoperative tracheostomy in a multi-institutional registry.MethodsThe Society of Thoracic Surgeons Congenital Heart Database (2000 to 2014) was queried for all index operations with the adverse event “postoperative tracheostomy” or “respiratory failure, requiring tracheostomy.” Patients with preoperative tracheostomy or weighing less than 2.5 kg undergoing isolated closure of patent ductus arteriosus were excluded. Trends in tracheostomy incidence over time from January 2000 to June 2014 were analyzed with a Cochran-Armitage test. The patient characteristics associated with operative mortality were analyzed for January 2010 to June 2014, including deaths occurring up to 6 months after transfer of patients to long-term care facilities.ResultsFrom 2000 to 2014, the incidence of tracheostomy after operations for congenital heart disease increased from 0.11% in 2000 to a high of 0.76% in 2012 (p?< 0.0001). From 2010 to 2014, 648 patients underwent tracheostomy. The median age at operation was 2.5 months (25th, 75th percentile: 0.4, 7). Prematurity (n?= 165, 26%), genetic abnormalities (n?= 298, 46%), and preoperative mechanical ventilation (n?= 275, 43%) were common. Postoperative adverse events were also common, including cardiac arrest (n?= 131, 20%), extracorporeal support (n?= 87, 13%), phrenic or laryngeal nerve injury (n?= 114, 18%), and neurologic deficit (n?= 51, 8%). The operative mortality was 25% (n?= 153).ConclusionsTracheostomy as an adverse event of operations for congenital heart disease remains rare but has been increasingly used over the past 15 years. This trend and the considerable mortality risk among patients requiring postoperative tracheostomy support the need for further research in this complex population.Congenital Heart Surgery:The Annals of Thoracic Surgery CME Program is located online at http://www.annalsthoracicsurgery.org/cme/home. To take the CME activity related to this article, you must have either an STS member or an individual non-member subscription to the journal.As the field of pediatric cardiovascular surgery has evolved, surgical repair or palliation in patients with?complex underlying cardiac lesions who often have?coexistent noncardiac comorbidities has become commonplace at most centers. Many of these patients have prolonged postoperative courses, including prolonged need for mechanical ventilation. In some cases, liberation from mechanical ventilation is not possible, and tracheostomy is considered. Several institutions have reported their experiences with pediatric patients requiring tracheostomy after cardiac operations [