Percutaneous tracheostomy after mechanical ventricular assist device implantation.
BACKGROUND
Several studies have shown that percutaneous dilational tracheostomy (PDT) is safe and cost-effective for patients recovering from surgery that requires a median sternotomy. We report our experience with PDT in patients receiving mechanical cardiac assistance.


METHODS
We reviewed the medical records of all patients who underwent ventricular assist device implantation at our institution between July 2000 and July 2003, and who subsequently required long-term ventilatory support during the same hospital admission. Data obtained from the records included demographic and biometric information, primary diagnosis, early (< or =30days) and late (>30days) complications, date and cause of death, type of anti-coagulation used at the time of tracheostomy, and various coagulation measures.


RESULTS
Thirty-one consecutive patients (29 men, 2 women; mean age, 56 years) had PDT after ventricular assist device implantation. Four minor complications occurred among 3 of the patients (10%), including 3 early complications (2 peristomal oozing and 1 peristomal cellulitis) and 1 late complication (recurrent peristomal cellulitis), none of which affected long-term outcome. No major adverse events, long-term complications, or deaths resulted from the PDT procedure.


CONCLUSIONS
PDT is feasible for patients with mechanical support devices who require long-term ventilatory support. Although some of these patients are coagulopathic, our results indicate that PDT is safe and effective in this challenging patient population.
Gregoric
Igor D
ID
Department of Cardiovascular Surgery, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas, USA.
Harting
Matthew T
MT
Kosir
Roman
R
Patel
Vijay S
VS
Ksela
Jus
J
Messner
Gregory N
GN
La Francesca
Saverio
S
Frazier
O H
OH
D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000150:complications / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D012306:Risk; D014139:Tracheostomy; D016896:Treatment Outcome