title: Tracheostomy Among Infants With Hypoplastic Left Heart Syndrome Undergoing Cardiac Operations: A Multicenter Analysis.
abstract: BACKGROUND
  Less than 2.7% of infants undergoing congenital heart disease operations have difficulty weaning from invasive mechanical ventilation. In such instances, clinicians may choose to perform tracheostomy. Limited literature has examined tracheostomy placement specifically in infants with hypoplastic left heart syndrome (HLHS). This study evaluated the risk factors for tracheostomy placement in infants with HLHS and examined the outcomes of these infants before their first hospital discharge.
  
  
  METHODS
  This retrospective analysis of the Pediatric Heath Information System data set included infants with HLHS who underwent stage 1 Norwood operation, a hybrid procedure, or heart transplant from 2004 through 2013.
  
  
  RESULTS
  We identified 5721 infants with HLHS, and 126 underwent tracheostomy placement. Infants in the tracheostomy group had more morbidities and a higher mortality rate across the study period. Diagnosis of chromosomal abnormalities, anomalies of the trachea and esophagus, larynx, diaphragm and nervous system, bilateral vocal cord paralysis, and necrotizing enterocolitis, and procedures including extracorporeal membrane oxygenation support, cardiac catheterization, and gastrostomy tube were independently associated with tracheostomy placement in the study population. Despite an overall increase in rates of tracheostomy performed in infants with HLHS during the study period, the mortality rate did not improve among tracheostomy patients.
  
  
  CONCLUSIONS
  Several risk factors were identified in infants with HLHS in whom a tracheostomy was placed during their first hospitalization. Despite an overall increase in rates of tracheostomies during the study period, the mortality rate did not improve among these patients. Appropriate family counseling and thorough preoperative case selection is suggested when discussing possible tracheostomy placement in infants with HLHS.
authors.affiliation: Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Pediatric Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas. Electronic address: prodhanparthak@uams.edu.
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.affiliation: Pulmonary Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Neonatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Nahed O
authors.initials: NO
authors.lastname: ElHassan
authors.affiliation: Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Elijah H
authors.initials: EH
authors.lastname: Bolin
authors.affiliation: Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Brandon
authors.initials: B
authors.lastname: Beam
authors.affiliation: Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; Pediatric Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Xiomara
authors.initials: X
authors.lastname: Garcia
authors.affiliation: Pediatric Cardiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Gaies
authors.affiliation: Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
mesh_terms: D005260:Female; D016027:Heart Transplantation; D006760:Hospitalization; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014139:Tracheostomy; D016896:Treatment Outcome