PURPOSE: We sought to determine risk factors for tracheostomy after mitral valve (MV) surgery.
METHODS: A retrospective analysis of 472 patients (mean age 66±14 years) who underwent MV surgery with or without other concomitant cardiac procedures from 2003–2005. Prospectively collected data included preoperative risk factors, cardiac status, intra-operative data, and morbidity.
RESULTS: In this study population, 22 patients (4.6%) required tracheostomy for long-term ventilation after MV surgery. On univariate analysis, patients were more likely to need a tracheostomy if they were older (72.3 vs 65.8, p<0.04), had a history of CAD (P<0.003), renal disease (CRI or ESRD, P<0.01) or prior cardiac operation (P<0.05). Intra-op factors significantly associated with post-operative tracheotomy included emergency valve operations (P<0.001), concomitant CABG (P<0.002) or need for IABP (P<0.0001). Patients requiring tracheostomy had lower starting ejection fractions (35% vs 50%, P<0.05) and required longer bypass times (138 vs 113 minutes, P< 0.02) On multivariate analysis, adjusted for age, renal disease (OR 9.9; 95% CI 1.7–10, P<0.002) and CAD (OR 5.6; 95% CI 1.2–16, p<0.02) remained significant. There were no significantly higher rates of tracheostomy in patients with a history of smoking or COPD.
CONCLUSION: Tracheostomy for respiratory failure is infrequent after mitral valve surgery, with a significantly higher incidence in patients with renal insufficiency (CRI or ESRD) or coronary artery disease.
CLINICAL IMPLICATIONS: Tracheostomy is a known event after mitral valve surgery. Prediction of patients at risk for tracheostomy may help prepare patients and clinicians for this event.
DISCLOSURE: Susan Trocciola, No Financial Disclosure Information; No Product/Research Disclosure Information