Tracheal surgery for airway anomalies associated with increased mortality in pediatric patients undergoing heart surgery: Society of Thoracic Surgeons Database analysis

J Thorac Cardiovasc Surg. 2021 Mar;161(3):1112-1121.e7. doi: 10.1016/j.jtcvs.2020.10.149. Epub 2020 Nov 27.


Objectives: Airway anomalies are common in children with cardiac disease but with an unquantified impact on outcomes. We sought to define the association between airway anomalies and tracheal surgery with cardiac surgery outcomes using the Society of Thoracic Surgery Congenital Heart Surgery Database.

Methods: Index cardiac operations in children aged less than 18 years (January 2010 to September 2018) were identified from the Society of Thoracic Surgery Congenital Heart Surgery Database. Patients were divided on the basis of reported diagnosis of an airway anomaly and subdivided on the basis of tracheal lesion and tracheal surgery. Multivariable analysis evaluated associations between airway disease and outcomes controlling for covariates from the Society of Thoracic Surgery Congenital Heart Surgery Database Mortality Risk Model.

Results: Of 198,674 index cardiovascular operations, 6861 (3.4%) were performed in patients with airway anomalies, including 428 patients (0.2%) who also underwent tracheal operations during the same hospitalization. Patients with airway anomalies underwent more complex cardiac operations (45% vs 36% Society of Thoracic Surgeons/European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality category ≥3 procedures) and had a higher prevalence of preoperative risk factors (73% vs 39%; both P < .001). In multivariable analysis, patients with airway anomalies had increased odds of major morbidity and tracheostomy (P < .001). Operative mortality was also increased in patients with airway anomalies, except those with malacia. Tracheal surgery within the same hospitalization increased the odds of operative mortality (adjusted odds ratio, 3.9; P < .0001), major morbidity (adjusted odds ratio, 3.7; P < .0001), and tracheostomy (adjusted odds ratio, 16.7; P < .0001).

Conclusions: Patients undergoing cardiac surgery and tracheal surgery are at significantly higher risk of morbidity and mortality than patients receiving cardiac surgery alone. Most of those with unoperated airway anomalies have higher morbidity and mortality, which makes it an important preoperative consideration.

Keywords: bronchi; congenital cardiac; trachea.

Publication types

  • Comparative Study
  • Webcast

MeSH terms

  • Adolescent
  • Age Factors
  • Canada
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / mortality*
  • Child
  • Child, Preschool
  • Databases, Factual
  • Female
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Male
  • Respiratory System Abnormalities / diagnostic imaging
  • Respiratory System Abnormalities / mortality
  • Respiratory System Abnormalities / surgery*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Thoracic Surgical Procedures / adverse effects
  • Thoracic Surgical Procedures / mortality*
  • Time Factors
  • Trachea / abnormalities
  • Trachea / diagnostic imaging
  • Trachea / surgery*
  • Treatment Outcome
  • United States