Outcomes of Tracheostomy in Children Requiring Surgery for Congenital Heart Disease

Abstract

Outcomes after discharge in children requiring tracheostomy after cardiac surgery have not been fully described. A retrospective, single-center study was performed on all children <18 years of age requiring both tracheostomy and surgery for congenital heart disease from January 2002 to May 2015. Forty-six tracheostomies were placed after surgery and four before. Single-ventricle anatomy was present in 12 (33%) patients. Incidence of tracheostomy after heart surgery increased from 0.8% the first half of the study period to 2% the second half. Median time between cardiac surgery and tracheostomy was 58 days. The most common indication for tracheostomy was multifactorial (30%) followed by airway malacia (22%). Median length to follow-up for survivors was 3.9 years (range 0.4-11.8 years). Survival to hospital discharge was 72%, and intermediate survival was 48%. Survival in those with systemic to pulmonary artery shunts at the time of tracheostomy was 22% compared to 59% for those with biventricular anatomy. Heart failure and multiple indications for tracheostomy were associated with worse outcome. There was no difference in survival for those discharged with a ventilator compared to those that were not. The most common cause of death after discharge was tracheostomy tube dislodgement/obstruction, accounting for 5 of 11 that died. Survival with a tracheostomy after cardiac surgery is poor, and children with systemic to pulmonary artery shunts are at especially high risk of death.

Risk factor analysis for mortality among infants requiring tracheostomy

“…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.…”

“…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.…”

“…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.…”

“…2,18,23 others have found that BPD and prematurity are independent risk factors for mortality in children with tracheostomy. 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.…”

“…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.…”