Percutaneous tracheostomy after mechanical ventricular assist device implantation

Area of Science:

• Cardiovascular Surgery
• Pulmonary Medicine
• Critical Care Medicine

Background:

• Percutaneous dilational tracheostomy (PDT) is established as safe and cost-effective for post-sternotomy patients.
• Mechanical cardiac assistance, such as ventricular assist devices (VADs), presents unique challenges for airway management.
• The safety and efficacy of PDT in patients with VADs requiring mechanical ventilation remain an area of interest.

Purpose of the Study:

• To evaluate the feasibility and safety of percutaneous dilational tracheostomy (PDT) in patients requiring mechanical cardiac assistance.
• To assess the complication rates associated with PDT in this specific patient population.
• To determine the long-term outcomes of PDT in patients with ventricular assist devices.

Main Methods:

• Retrospective review of medical records for patients who underwent ventricular assist device implantation and subsequent tracheostomy.
• Data collection included patient demographics, diagnoses, early and late complications, and coagulation status.
• Analysis focused on adverse events, mortality, and factors influencing outcomes related to PDT.

Main Results:

• Thirty-one patients (mean age 56 years) with VADs underwent PDT.
• A low rate of minor complications (10%) was observed, including peristomal oozing and cellulitis.
• No major adverse events, long-term complications, or deaths were directly attributed to the PDT procedure.

Conclusions:

• Percutaneous dilational tracheostomy (PDT) is a feasible and safe procedure for patients with mechanical cardiac support devices needing prolonged mechanical ventilation.
• Despite potential coagulopathy in some patients, PDT can be performed effectively in this challenging population.
• PDT offers a viable option for airway management in critically ill patients with ventricular assist devices.