Division of Pediatric Cardiology, 1259University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
Department of Cardiac Surgery, 1259University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
World J Pediatr Congenit Heart Surg. 2023 Mar;14(2):142-147. doi: 10.1177/21501351221133775. Epub 2023 Feb 23.
Approximately 0.2% to 2.7% of children with congenital heart disease require a tracheostomy after cardiac surgery with the majority having single ventricle (SV) type heart lesions. Tracheostomy in SV patients is reported to be associated with high mortality. We hypothesized that short- and long-term survival of patients with SV heart disease would vary according to tracheostomy indication.
This is a single center, 20-year, retrospective review of all patients with SV heart disease who underwent tracheostomy. Demographic, cardiac anatomy, surgical, intensive care unit, and hospital course data were collected. The primary outcome was survival following tracheostomy. Secondary outcome was the completion of staged palliation to Fontan.
In total, 25 patients with SV heart disease who underwent tracheostomy were included. Indications for tracheostomy included one or more of the following: tracheobronchomalacia (n = 8), vocal cord paralysis (n = 7), tracheal/subglottic stenosis (n = 6), primary respiratory insufficiency (n = 4), diaphragm paralysis (n = 3), suboptimal hemodynamics (n = 2), and other upper airway issues (n = 1). Survival at six months, one year, five years, and ten years was 76%, 68%, 63%, and 49%, respectively. Most patients completed Fontan palliation (64%). Patients who underwent tracheostomy for suboptimal hemodynamics and/or respiratory insufficiency had a higher mortality risk compared to those with indications of upper airway obstruction or diaphragm paralysis (hazard ratio 4.1, 95% confidence interval 1.2-13.7; = .02).
Mortality risk varies according to tracheostomy indication in patients with SV heart disease. Tracheostomy may allow staged surgical palliation to proceed with acceptable risk if it was indicated for anatomic or functional airway dysfunction.
约有 0.2%至 2.7%的先天性心脏病患儿在心脏手术后需要行气管切开术，其中大多数患儿存在单心室（SV）型心脏病变。有报道称，SV 型心脏病患者行气管切开术与高死亡率相关。我们假设 SV 型心脏病患者的短期和长期生存率将根据气管切开术的适应证而有所不同。
这是一项单中心、20 年回顾性研究，纳入了所有接受气管切开术的 SV 型心脏病患者。收集了人口统计学、心脏解剖、手术、重症监护病房和住院过程的数据。主要结局是气管切开术后的生存率。次要结局是完成分期姑息性 Fontan 手术。
共纳入 25 例接受气管切开术的 SV 型心脏病患者。气管切开术的适应证包括以下一种或多种情况：气管支气管软化（n=8）、声带麻痹（n=7）、气管/声门下狭窄（n=6）、原发性呼吸功能不全（n=4）、膈肌麻痹（n=3）、血流动力学不佳（n=2）和其他上呼吸道问题（n=1）。术后 6 个月、1 年、5 年和 10 年的生存率分别为 76%、68%、63%和 49%。大多数患者完成了 Fontan 姑息性手术（64%）。与上呼吸道梗阻或膈肌麻痹患者相比，因血流动力学不佳和/或呼吸功能不全而行气管切开术的患者死亡率风险更高（风险比 4.1，95%置信区间 1.2-13.7；P=0.02）。
SV 型心脏病患者的死亡率风险因气管切开术的适应证而异。如果气管切开术是由于解剖或功能气道功能障碍引起的，则可以进行分期手术姑息治疗，风险可接受。
