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

Mastropietro, Christopher W.; Benneyworth, Brian D.; Turrentine, Mark W.; Wallace, Amelia S.; Hornik, Christoph P.; Jacobs, Jeffrey P.; Jacobs, Marshall L.

doi:10.1016/j.athoracsur.2016.01.046

Cited by 38 publications

(91 citation statements)

References 14 publications

(27 reference statements)

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“…These findings were not related to higher rates of prematurity, lower gestational weights, or younger gestational ages in this group. The findings of increased mortality in infants with CHD are similar to other studies evaluating tracheostomy in pediatric patients of all ages with cardiac disease . For example, Funamura et al reported 27.5% mortality in children with CHD at various periods of follow‐up, which was significantly higher than patients without cardiac disease.…”

Section: Discussionsupporting

confidence: 82%

“…For example, Funamura et al reported 27.5% mortality in children with CHD at various periods of follow‐up, which was significantly higher than patients without cardiac disease. Several other studies have evaluated in‐hospital mortality after pediatric tracheostomy and reported high rates of mortality in cardiac patients ranging from 22% to 40% . These studies include a wide age range of children, mostly 0‐18 years, with CHD who have various associated comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…The findings of increased mortality in infants with CHD are similar to other studies evaluating tracheostomy in pediatric patients of all ages with cardiac disease. [3][4][5][21][22][23][24][25][26][27][28] For example, Funamura et al 21 reported 27.5% mortality in children with CHD at various periods of follow-up, which was significantly higher than patients without cardiac disease.…”

Section: Cardiac Patientsmentioning

confidence: 99%

“…In comparison to earlier decades when tracheostomy was used mainly for airway protection after infection, the procedure now is used commonly for infants with complex cardiopulmonary disorders, and need for long‐term ventilation . The number of tracheostomies performed for children with bronchopulmonary dysplasia (BPD) and cardiac disease has increased . With the evolving indications for this procedure, there is an urgent need to characterize long‐term outcomes, including mortality.…”

Section: Introductionmentioning

confidence: 99%

“…21,24 Compared with BPD, overall rates of tracheostomy placement in children with congenital heart disease (CHD) remain relatively low 4,25,26 ; however, there has been an increase in tracheostomy placement in cardiac patients over the last 15 years. [4][5] There are a limited number of studies evaluating mortality after tracheostomy in patients with CHD that report higher rates of mortality than noncardiac patients. [3][4][5][21][22][23][24][25][26][27][28] Given the limited data surrounding infant tracheostomy in the modern era, we evaluated mortality in infants ≤12 months of age who had tracheostomy placement, including infants with BPD and CHD.…”

mentioning

confidence: 99%

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Risk factor analysis for mortality among infants requiring tracheostomy

Strang

Briddell

Barth

et al. 2018

Pediatric Pulmonology

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Cardiac Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Risk factor analysis for mortality among infants requiring tracheostomy

Strang

Briddell

Barth

et al. 2018

Pediatric Pulmonology

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Perioperative and Long‐Term Outcomes in Infants Undergoing a Tracheostomy from a Neonatal Intensive Care Unit

Lambert,

Ramaswamy,

Gowda

et al. 2023

The Laryngoscope

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ObjectiveThe purpose of this study was to identify risk factors for perioperative complications and long‐term morbidity in infants from the neonatal intensive care unit (NICU) presenting for a tracheostomy.MethodsThis single‐center retrospective cohort study included infants in the NICU presenting for a tracheostomy from August 2011 to December 2019. Primary outcomes were categorized as either a perioperative complication or long‐term morbidity. A severe perioperative complication was defined as having either (1) an intraoperative cardiopulmonary arrest, (2) an intraoperative death, (3) a postoperative cardiopulmonary arrest within 30 days of the procedure, or (4) a postoperative death within 30 days of the procedure. Long‐term morbidities included (1) the need for gastrostomy tube placement within the tracheostomy hospitalization and (2) the need for diuretic therapy, pulmonary hypertensive therapy, oxygen, or mechanical ventilation at 12 and 24 months following the tracheostomy.ResultsOne‐hundred eighty‐three children underwent a tracheostomy. The mean age at tracheostomy was 16.9 weeks while the mean post‐conceptual age at tracheostomy was 49.7 weeks. The incidence of severe perioperative complications was 4.4% (n = 8) with the number of pulmonary hypertension medication classes preoperatively (OR: 3.64, 95% CI: (1.44–8.94), p = 0.005) as a significant risk factor. Approximately 81% of children additionally had a gastrostomy tube placed at the time of the tracheostomy, and 62% were ventilator‐dependent 2 years following their tracheostomy.ConclusionOur study provides critical perioperative complications and long‐term morbidity data to neonatologists, pediatricians, surgeons, anesthesiologists, and families in the expected course of infants from the NICU presenting for a tracheostomy.Level of EvidenceLevel 3 Laryngoscope, 2023

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Outcomes of pediatric tracheostomy after surgery for congenital heart disease: A 20‐year experience

Puchi,

Lavin,

Eltayeb

et al. 2023

Laryngoscope Investig Oto

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ObjectiveChildren with congenital heart defects (CHD) requiring cardiovascular surgery (CVS) rarely require tracheostomy placement; however the mortality rate remains high. The study aimed to analyze the incidence of tracheostomy in children with CHD, and to determine factors contributing to postoperative outcomes, decannulation rates, and mortality.MethodsRetrospective case series of children ≤18 years old with CHD status post‐CVS who underwent tracheostomy placement between January 1, 2001 and December 31, 2020. Variables analyzed included demographic information, presence of comorbidities including prematurity, respiratory diseases, presence of genetic syndromes, decannulation status, type of repair (univentricular vs. biventricular), and need for cardiopulmonary bypass. Adverse events analyzed included all‐cause mortality, development of mediastinitis, fatal decannulation, and persistence of tracheocutaneous fistula.ResultsFifty‐one patients were analyzed. The incidence of tracheostomy was 0.8%. Median age at tracheostomy was 5.3 months. The 5‐year survival estimate was 56.3% (95% confidence interval 43.6%, 72.6%). Age ≤6 months at the time of tracheostomy placement (p = .03), and the presence of tracheomalacia (p = .04) were factors significantly associated with 5‐year survival. Two patients (3.9%) experienced fatal decannulation, and one patient (2.0%) developed postoperative mediastinitis. The 10‐year decannulation rate estimate was 47.8% (30.5%, 63.2%). Seven patients (13.7%) had a persistent tracheocutaneous fistula.ConclusionsThis study corroborates high mortality rates in this population. Factors associated with improved survival were younger age at the time of tracheostomy and presence of tracheomalacia. Decannulation rates were low, but estimates improved over 10 years. Further studies are needed to determine optimal indications and timing for tracheostomy placement in this patient population.Level of Evidence4

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

Abstract: Background: Information concerning tracheostomy after surgery for congenital heart

Cited by 38 publications

References 14 publications

Risk factor analysis for mortality among infants requiring tracheostomy

Risk factor analysis for mortality among infants requiring tracheostomy

Perioperative and Long‐Term Outcomes in Infants Undergoing a Tracheostomy from a Neonatal Intensive Care Unit

Outcomes of pediatric tracheostomy after surgery for congenital heart disease: A 20‐year experience

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