Tracheostomy Among Infants With Hypoplastic Left Heart Syndrome Undergoing Cardiac Operations: A Multicenter Analysis

Abstract

Several risk factors were identified in infants with HLHS in whom a tracheostomy was placed during their first hospitalization. Despite an overall increase in rates of tracheostomies during the study period, the mortality rate did not improve among these patients. Appropriate family counseling and thorough preoperative case selection is suggested when discussing possible tracheostomy placement in infants with HLHS.

Hospital outcomes for pediatric heart transplant recipients undergoing tracheostomy: A multi‐institutional analysis

“…3,[15][16][17][18][19][20]22 We also found that children undergoing tracheostomy following HTx are at increased risk for mortality, consistent with previous reports of post-operative tracheostomy following surgery for CHD is associated with increased mortality. 15,17,20,25 The in-hospital mortality rate for Post-TT (20%) was less than half the mortality rate following post-surgical tracheostomy in infants with hypoplastic left heart syndrome (44%), 19 although, not surprisingly, it was considerably higher than the in-hospital mortality rate following post-surgical tracheostomy in patients with a ventricular septal defect (7%). 19 For tracheostomy following pediatric cardiac surgery, higher surgical risk is independently associated with increased in-hospital mortality.…”

“…It is common for children awaiting HTx to be ventilator-dependent, 5,6 and tracheostomy is increasingly being performed in children with cardiac disease. 15,[18][19][20] As the field of HTx evolves to address the challenges of the diverse group of children who reach end-stage heart failure, 21 it is important to determine if Pre-TT and Post-TT are associated with worse overall post-HTx outcomes. The purpose of this study was to describe the prevalence of tracheostomy in children with HTx and to compare the in-hospital mortality rates and utilization of resources among children with Pre-TT, Post-TT, and HTx without tracheostomy.…”

Outcomes of Vocal Fold Motion Impairment and Dysphagia after Pediatric Cardiothoracic Surgery: A Systematic Review

“…Bilateral VFMI was present in 2 of 3 subjects requiring a tracheotomy in the Alfares et al study, and this is consistent with other studies that reported a higher rate of tracheotomy with after CHS. 18,19 LoTempio and Shapiro 31 reported initial successful decannulation in 2 of 6 subjects with VFMI and tracheostomies; however, 1 required replacement of the tracheotomy during the long-term follow-up period. Voice assessment data were scarce; however, Skinner et al 13 reported that a weak cry was noted in 5 of 7 subjects with VFMI on initial assessment, and this was statistically significant.…”

Noteworthy Literature Published in 2016

“…The authors recommend appropriate family counseling and case selection when discussing a possible tracheostomy as a means of improving survival in this patient population. 22 Postextubation airway complications for uncuffed and cuffed endotracheal tubes (ETTs) are variously reported to range from 1% to 7.4%. 23 A recent study looking at 208 infants weighing less than 5 kg intubated with a microcuff ETT, undergoing cardiac surgery over a 5-year period at one institution, found a postextubation stridor rate of 20% and 1% incidence of severe stridor requiring reintubation.…”

“…The authors recommend appropriate family counseling and case selection when discussing a possible tracheostomy as a means of improving survival in this patient population. 22…”