title: Tracheostomy Following Surgery for Congenital Heart Disease: A 14-year Institutional Experience.
abstract: Tracheostomy following congenital heart disease (CHD) surgery is a rare event and associated with significant mortality. Hospital survival has been reported from 20% to 40%. Late mortality for these patients is not well characterized.
  
  
  
  We performed a retrospective observational study of patients who had a tracheostomy following CHD surgery (excluding isolated patent ductus arteriosus ligation) between January 2000 and December 2013. Patients were categorized into single-ventricle or biventricular physiology groups. Demographics, genetic syndromes, pulmonary disease, and comorbidities were collected. Outcomes including hospital survival, long-term survival, and weaning from positive pressure ventilation are reported. Bivariate and time-to-event models were used.
  
  
  
  Over a 14-year period, 61 children (0.9% incidence) had a tracheostomy placed following CHD surgery. There were 12 single-ventricle patients and 49 biventricular patients. Prematurity, genetic syndromes, lung/airway disease, and other comorbidities were common in both CHD groups. Gastrostomy tubes were used more frequently in biventricular physiology patients (91.8%) versus single-ventricle patients (66.7%, P = .04). Survival to hospital discharge was 50% in the single-ventricle group compared to 86% in biventricular patients (P = .01). Long-term survival continued to be poor in the single-ventricle group comparatively (three years, 27.8% vs 64.8%, P = .01). Gastrostomy tube placement was independently associated with survival in both groups (P = .002).
  
  
  
  Tracheostomy is performed following many types of surgery for CHD and is commonly associated with other comorbidities. Both hospital and long-term survival are substantially lower in children with single-ventricle physiology as compared to patients with biventricular physiology.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA bbenneyw@iu.edu.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Benneyworth
authors.affiliation: Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Shao
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: A Ioana
authors.initials: AI
authors.lastname: Cristea
authors.affiliation: Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Veda
authors.initials: V
authors.lastname: Ackerman
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Rodefeld
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Turrentine
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Brown
mesh_terms: D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014139:Tracheostomy / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: complications; congenital heart disease (CHD); morbidity); outcomes (includes mortality; statistics; surgery; survival analysis; tracheostomy