Tracheostomy Following Surgery for Congenital Heart Disease: A 14-year Institutional Experience.
Citation: World Journal for Pediatric & Congenital Heart Surgery. 7(3):360-6, 2016 05PMID: 27142405Institution: MedStar Washington Hospital CenterDepartment: SurgeryForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Heart Defects, Congenital/su [Surgery] | Female | Heart Defects, Congenital/mo [Mortality] | Humans | Incidence | Infant | Infant, Newborn | Kaplan-Meier Estimate | Male | Proportional Hazards Models | Retrospective Studies | Tracheostomy/sn [Statistics & Numerical Data] | Treatment OutcomeYear: 2016ISSN:- 2150-1351
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 27142405 | Available | 27142405 |
BACKGROUND: Tracheostomy following congenital heart disease (CHD) surgery is a rare event and associated with significant mortality. Hospital survival has been reported from 20% to 40%. Late mortality for these patients is not well characterized.
CONCLUSION: Tracheostomy is performed following many types of surgery for CHD and is commonly associated with other comorbidities. Both hospital and long-term survival are substantially lower in children with single-ventricle physiology as compared to patients with biventricular physiology.
Copyright © The Author(s) 2016.
METHODS: We performed a retrospective observational study of patients who had a tracheostomy following CHD surgery (excluding isolated patent ductus arteriosus ligation) between January 2000 and December 2013. Patients were categorized into single-ventricle or biventricular physiology groups. Demographics, genetic syndromes, pulmonary disease, and comorbidities were collected. Outcomes including hospital survival, long-term survival, and weaning from positive pressure ventilation are reported. Bivariate and time-to-event models were used.
RESULTS: Over a 14-year period, 61 children (0.9% incidence) had a tracheostomy placed following CHD surgery. There were 12 single-ventricle patients and 49 biventricular patients. Prematurity, genetic syndromes, lung/airway disease, and other comorbidities were common in both CHD groups. Gastrostomy tubes were used more frequently in biventricular physiology patients (91.8%) versus single-ventricle patients (66.7%, P = .04). Survival to hospital discharge was 50% in the single-ventricle group compared to 86% in biventricular patients (P = .01). Long-term survival continued to be poor in the single-ventricle group comparatively (three years, 27.8% vs 64.8%, P = .01). Gastrostomy tube placement was independently associated with survival in both groups (P = .002).
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