Tracheoesophageal fistula and associated congenital heart disease: implications for anesthetic management and survival.
BACKGROUND
Infants with tracheoesophageal fistula (TEF) and/or esophageal atresia (EA) frequently have other associated congenital anomalies which can have a significant impact on their anesthetic care and survival to discharge.


METHODS
A medical record review and retrospective data analysis were performed in a university affiliated children's hospital of all infants undergoing TEF/EA repair between January 1998 and July 2004. The incidence of intraoperative complications during the TEF repair and overall survival to hospital discharge was compared in two groups of infants: 26 patients with TEF/EA and coexisting congenital heart disease (CHD), and 27 patients with TEF/EA and no CHD.


RESULTS
The overall incidence of intraoperative critical events during repair of TEF/EA was significantly higher in infants with associated cardiac pathology (P = 0.003). Six of 53 infants died during hospitalization (overall mortality, 11.3%) and all had associated cardiac pathology. In comparison with nonductal-dependent lesions, the presence of a ductal-dependent cardiac lesion appeared to significantly increase patient mortality (57% vs. 10%, P = 0.028).


CONCLUSIONS
Low birth weight (<1500 g) and associated cardiac pathology were found to be independent predictors of mortality in infants undergoing surgery for TEF/EA repair. The presence of a ductal-dependent cardiac lesion further increased the risk of morbidity and mortality, in addition to necessitating special anesthesia considerations.
Diaz
Laura K
LK
Division of Pediatric Cardiovascular Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, TX 77030, USA. lkdiaz@bcm.tmc.edu
Akpek
Elif A
EA
Dinavahi
Radhika
R
Andropoulos
Dean B
DB
D000768:Anesthesia, General; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007231:Infant, Newborn; D007431:Intraoperative Complications; D008297:Male; D008499:Medical Records; D011379:Prognosis; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*