(44 - Saturday) Improved outcomes of patients undergoing tracheostomy after congenital heart surgery with use of a multidisciplinary team - single center retrospective study
Pediatric Cardiologist, Assistant professor in Pediatrics Oklahoma Children's Hospital Oklahoma City, Oklahoma, United States
Abstract:
Introduction: Respiratory failure after cardiac surgery in infants is rare, but represents a serious medical challenge. Studies that investigate placement of tracheostomies using disciplinary collaboration with a streamlined approach after cardiac surgery are sparse. Our focus is to present and review experiences and outcomes of all pediatric patients after congenital heart surgeries at our institution who were placed on a tracheostomy using a multidisciplinary approach.
Methods: A single center retrospective review of all patients who have undergone tracheostomy placement after congenital heart surgery from University of Oklahoma between January 2014 to December 2021 were reviewed. Patient diagnosis, type of surgery, presence of genetic syndrome and associated extracardiac anomalies were reviewed. Length of stay in hospital, survival to hospital discharge. Median length of follow up, cause of death, number of survivors, number of patients who are decannulated.
Results: • A total of 2800 cardiac procedures were performed between January 2014 to December 2021 • A total of 28 (1%) patients required tracheostomy after cardiac surgery: 11 had single ventricle anatomy, 17 had biventricular anatomy • Follow up had a range between 15months-9years (Median of 5years) • A total of 68% (19/28)of the patients had a genetic syndrome or major noncardiac comorbidity: 45% (5/11) in the single ventricle group, and 82% (14/17) in the biventricular group • Hospital survival: 79% (22/28) of the patients survived hospitalization. 82% (9/11) in the single ventricle group and 76% (13/17) in the biventricular group. • Cause of death for the in-hospital death for the two patients in the single ventricle group: DiGeorge Syndrome in the 1st patient and Charge syndrome in the second patient, both patients had progressive systemic dynamic LVOT obstruction that needed DKS/BT shunt at 4-5months with death about 2months after surgery secondary to sepsis/SIRS which led to multiorgan failure. • Cause of death for the in-Hospital deaths for the 4 patients in the biventricular group: First patient had DiGeorge syndrome with Duodenal perforation culminating sepsis and death at 9mo. Second patient had DiGeorge syndrome and emphysema leading to progressive respiratory failure and death at 6mo. Third patient had congenital immunodeficiency resulting in recurrent respiratory and bloodstream infections and then death at 8mo. 4th patient had critical aortic stenosis requiring aortic homograft replacement in the setting of familial congenital myopathy resulting in death at death at 6months of age • 7/13 patients in the biventricular group who survived hospitalization had successful trach decannulation within 9months to three years (median 2years) from trach placement • 6/13 patients in the biventricular group who survived hospitalization had successful weaning off vent to trach collar but not have trach decannulation yet • Long-term survival: 64% (7/11) in the single ventricle and 76% (13/17) in the biventricular group. Cause of death after hospital discharge for the 2 pts in single ventricle group was sepsis in the 1st patient and unrecognized airway plug during a car drive in the second patient. No after-hospital death in the biventricular group.
