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Updated: Jun 1, 2025
Tracheotomy: A Method for Transplantation of Stem Cells to the Lung
Published on: February 25, 2007
Tracheostomy as a Management Option After Listing for Pediatric Cardiac Transplantation
Elisabeth Day1, Deborah Cross1, David Crossland2
1Paediatric Intensive Care, Freeman Hospital, Newcastle upon Tyne, UK.
Insights
Tracheostomy in children awaiting heart transplants is safe, with no impact on survival. This procedure aids in managing prolonged ventilation, improving quality of life for pediatric cardiac transplant candidates.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Critical Care Medicine
Background:
- Children with end-stage heart failure often require mechanical ventilation during cardiac transplant waiting periods.
- A subset of these pediatric patients cannot be weaned from ventilators, necessitating tracheostomy for improved quality of life and intensive care de-escalation.
- Evidence regarding tracheostomy use in pediatric cardiac transplantation is limited, highlighting the need for outcome data.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients undergoing tracheostomy while awaiting cardiac transplantation.
- To compare the safety and efficacy of tracheostomy in this specific patient population.
Main Methods:
- A retrospective, single-center study analyzed pediatric patients (<18 years) listed for cardiac transplant between 2006 and 2017.
- Data collected included demographics, cardiac diagnoses, complications, ventricular assist device use, and survival.
- Patients who received a tracheostomy post-listing were compared to those who did not.
Main Results:
- Of 211 listed patients, 44 (21%) underwent tracheostomy, primarily due to failure to wean from mechanical ventilation (36%).
- Tracheostomy-related complications were generally minor, including infection and obstruction. Median decannulation time was 75 days.
- No significant differences were observed in age, weight, or time to transplant between tracheostomy and non-tracheostomy groups. One-year survival rates were comparable (97% vs. 94%).
Conclusions:
- Tracheostomy in pediatric cardiac transplant candidates does not appear to be associated with significant complications or reduced survival.
- Tracheostomy is typically a short-term intervention and a viable management option for children requiring prolonged ventilation around cardiac transplantation.
Background:
Children with end-stage heart failure listed for cardiac transplantation may require mechanical ventilation and/or circulatory support whilst awaiting transplantation. A subgroup of these patients is unable to wean off mechanical ventilator support and undergo tracheostomy to enhance quality of life and allow de-escalation of intensive care. There is limited evidence of the use of tracheostomy associated with pediatric cardiac transplantation. We describe outcomes to better inform future management of these patients.
Methods:
A single-centre, retrospective study was performed, assessing all pediatric patients (< 18 years) listed for cardiac transplant from 2006 to 2017. We assessed background demographics and outcomes, including cardiac diagnosis, complications, insertion of ventricular assist device and survival. We identified patients who underwent tracheostomy after listing and compared this group with non-tracheostomised patients.
Results:
Two hundred and eleven patients were listed for cardiac transplant, of whom 44 (21%) underwent tracheostomy after listing. The main indication for tracheostomy was failure to wean from mechanical ventilation (36%). Complications after tracheostomy included localized infection, granuloma, obstruction and hemorrhage, but were generally minor. Median time for tracheostomy decannulation was 75 days. When comparing tracheostomy versus non-tracheostomy patients, there were no significant differences in age, weight or time to transplant. Survival was comparable between the non-tracheostomy and tracheostomy groups at 1-year, 97% versus 94% respectively.
Conclusion:
There is no evidence from our study that patients awaiting cardiac transplant who undergo tracheostomy have significant complications or reduced survival. Tracheostomy is usually a short-term measure and should be considered in the management of children receiving prolonged ventilation around the time of cardiac transplantation.
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