Skip to main content

Advertisement

Log in

Frequency and Indications for Tracheostomy and Gastrostomy After Congenital Heart Surgery

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Patients undergoing congenital heart surgery may occasionally require additional surgical procedures in the form of tracheostomy and gastrostomy. These procedures are often performed in an attempt to diminish hospital morbidity and length of stay. We reviewed the Web-based medical records of all patients undergoing congenital heart surgery at Miami Children’s Hospital from February 2002 through August 2007. Patients who were deemed preterm and had undergone closure of a patent ductus arteriosis were eliminated. The records of all other patients were queried for the terms gastrostomy, g-tube, Nissan, fundal plication, tracheostomy, or tracheotomy. Patients’ medical records in which these terms appeared in any portion were completely reviewed. There were 1660 congenital heart operations performed in the study period. There were 592 operations performed on patients whose age ranged from 1 month to 1 year and 441 neonatal operations. Mortality was 2%. Median postoperative stay was 8 days (range, 1–191 days), 12 days for neonates (range, 3–142 days), and 19 days for neonates undergoing RACHS-1 category 6 operations (range, 4–142 days). Tracheostomies were performed in four patients (0.2%). Gastrostomies were performed on eight patients (0.4%), representing 0.8% of patients <1 year of age, 1.4% of neonates, and 2.4% of patients undergoing RACHS-1 category 6 operations. The rate of patients undergoing either tracheostomy or gastrostomy after congenital heart surgery at our institution was quite low. Avoidance of either of these two procedures was achieved without increased morbidity or length of stay. The rate at which these procedures need to be performed may reflect the magnitude of the patients’ lifetime trauma related to their underlying condition and acute and total surgical experiences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ballweg JA, Dominguez TE, Ravishankar C, Kreutzer J, Marino BS, Bird GL, Gruber PJ, Wernovsky G, Gaynor JW, Nicolson SC, Spray TL, Tabbutt S (2007) A contemporary comparison of the effect of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcome at stage 2 reconstruction. J Thorac Cardiovasc Surg 134(2):297–303

    Article  PubMed  Google Scholar 

  2. Burke RP (2001) Reducing the trauma of congenital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 4:216–228

    Article  PubMed  CAS  Google Scholar 

  3. Burke RP, Zahn EM, Rossi AF (2004) Achieving resonance in a programme for congenital cardiac surgery. Cardiol Young 14(Suppl 1):75–82

    PubMed  Google Scholar 

  4. Checchia PA, McCollegan J, Daher N, Kolovos N, Levy F, Markovitz B (2005) The effect of surgical case volume on outcome after the Norwood procedure. J Thorac Cardiovasc Surg 129(4):754–759

    Article  PubMed  Google Scholar 

  5. Cua CL, Thiagarajan RR, Gauvreau K, Lai L, Costello JM, Wessel DL, Del Nido PJ, Mayer JE Jr, Newburger JW, Laussen PC (2006) Early postoperative outcomes in a series of infants with hypoplastic left heart syndrome undergoing stage I palliation operation with either modified Blalock-Taussig shunt or right ventricle to pulmonary artery conduit. Pediatr Crit Care Med 7(3):238–244

    Article  PubMed  Google Scholar 

  6. Davis GM (2006) Tracheostomy in children. Paediatr Respir Rev 7(Suppl 1):S206–S209

    Article  PubMed  Google Scholar 

  7. del Castillo SL, Moromisato DY, Dorey F, Ludwick J, Starnes VA, Wells WJ, Jeffries HE, Wong PC (2006) Mesenteric blood flow velocities in the newborn with single-ventricle physiology: modified Blalock-Taussig shunt versus right ventricle-pulmonary artery conduit. Pediatr Crit Care Med 7(2):132–137

    Article  PubMed  Google Scholar 

  8. Fishberger SB, Rossi AF, Bolivar JM, Lopez L, Hannan RL, Burke RP (2008) Congenital cardiac surgery without routine placement of wires for temporary pacing. Cardiol Young 18(1):96–99

    Article  PubMed  Google Scholar 

  9. Hannan RL, Ybarra MA, Ojito JW, Alonso FA, Rossi AF, Burke RP (2006) Complex neonatal single ventricle palliation using antegrade cerebral perfusion. Ann Thorac Surg 82(4):1278–1284

    Article  PubMed  Google Scholar 

  10. Harrison AM, Cox AC, Davis S, Piedmonte M, Drummond-Webb JJ, Mee RB (2002) Failed extubation after cardiac surgery in young children: prevalence, pathogenesis, and risk factors. Pediatr Crit Care Med 3(2):148–152

    Article  PubMed  Google Scholar 

  11. Harrison AM, Davis S, Reid JR, Morrison SC, Arrigain S, Connor JT, Temple ME (2005) Neonates with hypoplastic left heart syndrome have ultrasound evidence of abnormal superior mesenteric artery perfusion before and after the modified Norwood procedure. Pediatr Crit Care Med 6:445–447

    Article  PubMed  Google Scholar 

  12. Hoskote A, Cohen G, Goldman A, Shekerdemian L (2005) Tracheostomy in infants and children after cardiothoracic surgery: indications, associated risk factors, and timing. J Thorac Cardiovasc Surg 130(4):1086–1093

    Article  PubMed  Google Scholar 

  13. Jeffries HE, Wells WJ, Starnes VA, Wetzel RC, Moromisato DY (2006) Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome. Ann Thorac Surg 81(3):982–987

    Article  PubMed  Google Scholar 

  14. Jenkins KJ, Gauvreau K (2002) Center-specific differences in mortality: preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. J Thorac Cardiovasc Surg 124(1):97–104

    Article  PubMed  Google Scholar 

  15. Kelleher DK, Laussen P, Teixeira-Pinto A, Duggan C (2006) Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 22:237–244

    Article  PubMed  CAS  Google Scholar 

  16. Kemper KJ, Benson MS, Bishop MJ (1991) Predictors of postextubation stridor in pediatric trauma patients. Crit Care Med 19(3):352–355

    Article  PubMed  CAS  Google Scholar 

  17. LoTempio MM, Shapiro NL (2002) Tracheotomy tube placement in children following cardiothoracic surgery: indications and outcomes. Am J Otolaryngol 23(6):337–340

    Article  PubMed  Google Scholar 

  18. McElhinney DB, Hedrick HL, Bush DM, Pereira GR, Stafford PW, Gaynor JW, Spray TL, Wernovsky G (2000) Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 106(5):1080–1087

    Article  PubMed  CAS  Google Scholar 

  19. Nelson DP (2005) Paying more attention to morbidity in infants with hypoplastic left heart syndrome. Pediatr Crit Care Med 6(5):614–615

    Article  PubMed  Google Scholar 

  20. Pearl RH, Robie DK, Ein SH, Shandling B, Wesson DE, Superina R, Mctaggart K, Garcia VF, O’Connor JA, Filler RM (1990) Complications of gastroesophageal antireflux surgery in neurologically impaired versus neurologically normal children. J Pediatr Surg 25(11):1169–1173

    Article  PubMed  CAS  Google Scholar 

  21. Pigula FA, Gandhi SK, Siewers RD, Davis PJ, Webber SA, Nemoto EM (2001) Regional low-flow perfusion provides somatic circulatory support during neonatal aortic arch surgery. Ann Thorac Surg 72:401–407

    Article  PubMed  CAS  Google Scholar 

  22. Slater B, Rangel S, Ramamoorthy C, Abrajano C, Albanese CT (2007) Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome. J Pediatr Surg 42:1118–1121

    Article  PubMed  Google Scholar 

  23. Torres A, DiLiberti J, Pearl RH, Wohrley J, Raff GW, Bysani GK, Bond LM, Geiss DM (2002) Noncardiac surgery in children with hypoplastic left heart syndrome. J Pediatr Surg 37:1399–1403

    Article  PubMed  Google Scholar 

  24. Watier-Launey C, Buronfosse A, Saliba E, Bertrand P, Ployet M-J (2000) Predictive factors for complications in children with laryngeal damage at extubation. Laryngoscope 110(2 Part 1):328

    Article  PubMed  CAS  Google Scholar 

  25. Zahn EM, Dobrolet NC, Nykanen DG, Ojito J, Hannan RL, Burke RP (2004) Interventional catheterization performed in the early postoperative period after congenital heart surgery in children. J Am Coll Cardiol 43(7):1264–1269

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors acknowledge the efforts of Lissette Cruz in manuscript preparation and submission to our hospital Institutional Review Board.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anthony F. Rossi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rossi, A.F., Fishberger, S., Hannan, R.L. et al. Frequency and Indications for Tracheostomy and Gastrostomy After Congenital Heart Surgery. Pediatr Cardiol 30, 225–231 (2009). https://doi.org/10.1007/s00246-008-9324-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-008-9324-y

Keywords

Navigation