Role of Tracheostomy in Pediatric Patients Who Underwent Heart Surgery: A Single-Center Experience

Abstract

Objectives: This study aimed to review the characteristics and outcomes of children with congenital heart disease requiring tracheostomy after cardiac surgery. Methods: Medical records of 65 out of 2814 consecutive patients who required tracheostomy after congenital heart surgery between March 2018 and March 2023 were retrospectively reviewed. Outcomes such as hospital survival, long-term survival, and weaning from positive pressure ventilation were elucidated. Results: During the 5-year period, a total of 65 of 2814 (2.3%) patients required tracheostomy in the pediatric intensive care unit after surgery. The median patient age was 5 (range, 0.6-24) months and the median weight was 4.3 kg (range, 3.3-11). A total of 23 (35.5%) patients demonstrated a single-ventricle physiology while 42 (64.5%) patients manifested with biventricle physiology. A total of 11 (16.9%) patients were syndromic, including Down syndrome in 6 patients, Di George syndrome in 3 patients, and Williams syndrome in 2 patients. In the whole cohort (65 patients), the mean time to tracheostomy from cardiac surgery was 30±16 days. In-hospital mortality was noted in 20 of the patients (30.8%) who underwent tracheostomy. Twenty-six patients (40%) were decannulated and discharged without a tracheostomy, and 14 patients (22%) were discharged with a tracheostomy cannula and home-type mechanical ventilator (HMV). Conclusion:Tracheostomy is a viable option for pediatric patients with prolonged mechanical ventilation after heart surgery for congenital heart disease. It creates an opportunity to discharge patients on HMV, if repeated attempts of extubation and decannulation fail, albeit with potential risks.