Original article
Congenital heart surgery
Tracheostomy Among Infants With Hypoplastic Left Heart Syndrome Undergoing Cardiac Operations: A Multicenter Analysis

https://doi.org/10.1016/j.athoracsur.2016.09.016Get rights and content

Background

Less than 2.7% of infants undergoing congenital heart disease operations have difficulty weaning from invasive mechanical ventilation. In such instances, clinicians may choose to perform tracheostomy. Limited literature has examined tracheostomy placement specifically in infants with hypoplastic left heart syndrome (HLHS). This study evaluated the risk factors for tracheostomy placement in infants with HLHS and examined the outcomes of these infants before their first hospital discharge.

Methods

This retrospective analysis of the Pediatric Heath Information System data set included infants with HLHS who underwent stage 1 Norwood operation, a hybrid procedure, or heart transplant from 2004 through 2013.

Results

We identified 5721 infants with HLHS, and 126 underwent tracheostomy placement. Infants in the tracheostomy group had more morbidities and a higher mortality rate across the study period. Diagnosis of chromosomal abnormalities, anomalies of the trachea and esophagus, larynx, diaphragm and nervous system, bilateral vocal cord paralysis, and necrotizing enterocolitis, and procedures including extracorporeal membrane oxygenation support, cardiac catheterization, and gastrostomy tube were independently associated with tracheostomy placement in the study population. Despite an overall increase in rates of tracheostomy performed in infants with HLHS during the study period, the mortality rate did not improve among tracheostomy patients.

Conclusions

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.

Section snippets

Patients and Methods

This University of Arkansas for Medical Sciences Institutional Review Board approved this study.

Results

Among 5,721 infants with HLHS undergoing initial palliation or heart transplantation, or both, tracheostomy was performed in 126 patients (2.3%) during the study period (Table 1). The tracheostomy rates were significantly higher in the recent eras (1.9% in 2004 to 2006 vs 3% in 2010 to 2013, p = 0.04; 1.4% in 2007 to 2009 vs 3.0% in 2010 to 2013, p = 0.0007; and 1.9% in 2004 to 2006 vs 1.4% in 2007 to 2009, p = 0.24). Approximately 50% of tracheostomies were noted in patients undergoing stage 1

Comment

In this multiinstitutional retrospective investigation, we examined the clinical characteristics and short-term outcomes of infants with HLHS who had a tracheostomy during their first hospitalization for a palliative operation or heart transplantation, or both, and then identified unique risk factors associated with this procedure. Despite an overall increase in the rates of tracheostomy performed during the study period, the mortality rate did not improve among patients who underwent

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