Abstract 17115: Airway Anomalies and Respiratory Factors Significantly Impact Post-operative Intensive Care Management in Patients With Trisomy 13 and 18 Following Cardiac Surgery
Introduction: Congenital heart disease is common in individuals with trisomy 13 and 18 (T13/18). While excellent survival after cardiac surgery is reported, there are limited data describing the impact of comorbidities, specifically airway anomalies, on the current intensive care (ICU) management strategies and outcomes.
Hypothesis: Airway anomalies are common and significantly impact post-operative management and outcomes in T13/18 patients following cardiac surgery when compared to an age-matched cohort.
Methods: We performed a retrospective nested case-control study of all patients with known T13/18 who underwent cardiac operations at our institution from 1994-2014. A control group of 3:1 age-matched non-T13/18 patients who underwent a similar surgery was used for comparison. Patient demographics and clinical characteristics including post-operative course and management were compared. Descriptive statistics (median, interquartile range [IQR]) and Wilcoxon unpaired rank t-tests were used to determine significant differences.
Results: Fourteen patients with T13 (14%) or T18 (86%) underwent cardiac surgery (median age: 93 days) for ventricular septal defect (VSD) (n=8), VSD with coarctation (n=2), atrioventricular septal defect (n=2) and tetralogy of Fallot (n=2). There was 1 mortality. Hospital length of stay (LOS) was longer in the T13/18 cohort (31 days [IQR: 20-40] versus 8 days [IQR: 6-15], p<0.0001), as was ICU LOS (14 days [IQR: 7-24] versus 4 days [IQR: 2-5], p<0.0001). The duration of intubation (7 versus 2 days, p < 0.0001) was longer as was the duration of non-invasive positive pressure ventilation (NIPPV) (8 versus 3 days, p < 0.0002). More T13/18 patients required NIPPV (71% vs. 42%) and 2 required a tracheostomy. Airway anomalies were found in 6 (43%) T13/18 patients, all bronchomalacia, compared to 1 control patient (2%) born prematurely with chronic lung disease.
Conclusions: The majority of T13/18 patients survive cardiac surgery, but have a prolonged hospital course compared to controls. T13/18 patients appear to have increased airway complications, including the need for tracheostomy or prolonged NIPPV. Parental guidance prior to cardiac surgery should include a discussion about post-operative airway management.
Author Disclosures: S.K. Swanson: None. K.R. Schumacher: None. R.G. Ohye: None. J.D. Zampi: None.
- © 2016 by American Heart Association, Inc.