Single-center experience of outcomes of tracheostomy in children with congenital heart disease.

OBJECTIVE: A subset of children with repaired congenital heart disease (CHD) may require tracheostomy for ongoing ventilatory support. Data on outcomes of children with CHD and tracheostomy are scarce. Our objectives were to describe indications for tracheostomy and outcomes, including readmission data in this population. METHODS: This is a retrospective chart review of children (<18 years old) with CHD who underwent tracheostomy at a single center over a 12-year period. Exclusion criteria were prematurity with isolated patent ductus arteriosus ligation. Outcomes until discharge and data on all readmissions after the initial discharge were reviewed. RESULTS: A total of 21 subjects with CHD underwent tracheostomy at a median (range) age of 4 (1-84) months and mean (standard deviation) weight of 7.2 (5.9) kg. The most common indication for tracheostomy was tracheomalacia with ventilator-dependent respiratory failure (14/21 subjects), followed by subglottic stenosis (5) and vocal cord palsy (2). Genetic syndromes were present in 13 (62%) subjects. The mean (standard deviation) post-tracheostomy length of stay was 55 (35) days. All subjects survived to discharge; 17 (81%) required home ventilation. A total of 11 (52%) subjects died during follow-up, all of whom were mechanically ventilated while three (14%) children underwent successful decannulation. The mean number of nonelective readmissions decreased from 2.4/patient-year in the first year to 1.4/patient-year in the second year, respectively. The commonest reasons for readmission were respiratory deterioration, infections, and mechanical tracheostomy-related problems. CONCLUSIONS: The majority of children with CHD who underwent tracheostomy did so for ventilator dependence and tracheomalacia and had coexisting genetic syndromes. About half the cohort died; among survivors, readmissions were common but decreased after the first year. These results underscore the ongoing mortality and morbidity risks faced by this vulnerable population.

Early and long term outcome in children with esophageal atresia treated over the last 22 years.

BACKGROUND: The survival of infants born with esophageal atresia (EA) is > 90% at present. The purpose of this study was to evaluate early complications and long term outcome in children with EA treated at our institution. METHODS AND PATIENTS: Retrospective analysis of 111 children with EA undergoing repair of EA or tracheoesophageal fistula (TEF). Assessment of early and intermediate complications as well as long term morbidity and mortality. RESULTS: Primary anastomosis was performed in 90 (81%) and secondary anastomosis in 7 patients (6%). Gastric transposition was carried out in 14 children (13%). The postoperative mortality was 14/111 (12.6%) and could be estimated by the Spitz classification. At the age of 10 years, 33 patients (72%) were swallowing without problems, 39 children (85%) were eating at least most of the time with pleasure but 19 children (41%) had a body weight less than the 25 (th) percentile. Staged repair by gastric transposition resulted in the least amount of motility dysfunction. Long-term respiratory morbidity was high. CONCLUSION: The survival of children with EA has improved in the last two decades. For risk assessment the Spitz' classification is valid. Long term gastrointestinal and respiratory morbidity remains high. In children with long-gap EA gastric transposition performed as a staged procedure has satisfactory results and seems superior to techniques preserving the native esophagus.