UMIN Clinical Trials Registry UMIN000006832 (December 4, 2011).

mediate-term clinical outcomes and can also serve as a predictor of need for reintervention regardless of patient age and disease complexity. 4,5 Methods Patients and Surgical Procedure The National Cerebral and Cardiovascular Center Institutional Review Board approved this retrospective study, and opt-out consent was obtained instead of individual written informed consent (R19043-2). A total of 159 consecutive patients undergoing repair of TOF primarily or after systemic to pulmonary shunt between 2001 and 2015 were enrolled (Table 1). Patients with major aortopulmonary collateral arteries, atrioventricular septal defect, or absent pulmonary valve were excluded. Mean age and body weight at repair were 12.7±6.6 months and 7.9±1.7 kg, respectively. Nineteen patients (11.9%) had pulmonary atresia, and 77 patients (48.4%) had undergone palliative systemic to pulmonary shunt through lateral thoracotomy. TOF repair was performed at between 2 months and 2 years of age following preoperative cardiac catheter evaluation. The patients with pulmonary atresia (11.9%) under

The complication rate after emergency tracheostomy is two to five times greater than after elective procedures. One of the main causes of the high risk of complications in emergency tracheostomy appears to be the amount of time required to open the trachea. Therefore, simple and fast procedures are mandatory. We have developed a new procedure as follows: A horizontal skin incision is performed. Strap muscles are dissected and retracted laterally. A transverse cut between tracheal rings below the thyroid isthmus is performed up to membranous portion of the trachea. The cut ends of the trachea remain open naturally because of the elasticity of the trachea. Skin and tracheal cut-ends are then joined by interrupted sutures.We have used this procedure during the past three years and have not experienced any major complications. This demonstrates the clear advantage and the more physiological nature of the procedure over various other incisions of the tracheal wall.

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