Pediatric Cardiology and Cardiac Surgery
Vol.26 No.5 2010 (375-383)
Ayako Maruo,1) Yoshihiro Oshima,1) Masahiro Yoshida,1) Chikashi Shimazu,1) Tomonori Higuma,1) Takeshi Inoue,1) and Masahiro Yamaguchi2)
1)Department of Cardiovascular Surgery, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan 2)Department of Cardiovascular Surgery, Akashi Medical Center, Hyogo, Japan
Objective: To determine the profiles of our patients with concomitant congenital heart disease and airway obstructive lesions and to evaluate the surgical results.
Methods: 70 patients with congenital heart disease and airway obstructive lesions were retrospectively studied. Fifty patients had tracheal stenosis, and 20 had tracheobronchomalacia. For tracheal stenosis, 43 tracheoplasties including 35 simultaneous repairs of associated cardiovascular lesions were performed. Six patients had tracheoplasties after cardiovascular repairs, of which only one patient had an intended staged repair. Two patients had re-tracheoplasties. Seven patients had no tracheal repair. Twelve patients out of 20 with tracheobronchomalacia had pexis of great vessels to the sternum, and the 8 remaining patients had cardiovascular repairs only. The clinical results of these patients were retrospectively investigated.
Results: Among the 35 patients who underwent simultaneous tracheal and cardiovascular repair, four patients died in the hospital. Univariate analysis revealed the following risk factors for in-hospital mortality: existence of intracardiac defects (p=0.046), delayed sternal closure (p=0.02), postoperative peritoneal dialysis (p=0.0007), and longer duration of cardiopulmonary bypass (survivor: 206±68 minutes versus non-survivor: 309±61 minutes, p=0.007), although none of these were defined as significant using multivariate analysis. Postoperative morbidities occurred in 6 patients: 2 mediastinitis, 1 cerebral infarction, and 3 hypoxic encephalopathy. Extubation was successfully carried out in 22 patients (66%). Three patients died late in the follow-up period. No mortalities were identified among the staged repair patients. There were no in-hospital deaths in the tracheobronchomalacia patients. Extubation was successfully achieved in 18 patients (85%). Two patients died late in the follow-up period.
Conclusions: The results of the simultaneous repair of tracheal stenosis and cardiovascular lesions were acceptable. The analysis of risk factors suggests that alternative staged repair should be considered for patients who require longer bypass time and following peritoneal dialysis or an opened sternal wound. Our therapeutic strategy including pexis for associated tracheobronchomalacia provided satisfactory results.