Impact of trisomy 13 and 18 on airway anomalies and pulmonary complications after cardiac surgery

Objective: To determine the prevalence and influence of clinically significant airway and/or respiratory abnormalities in patients with trisomy 13 and 18 undergoing cardiac surgery.

Methods: We performed a retrospective, case-control cohort study of all patients with known trisomy 13 or 18 who underwent cardiac operations at our institution from 1994 to 2014. Cases were matched 3:1 by age, surgical date, and cardiac lesion with nontrisomy 13/18 patients. Baseline clinical characteristics and patient outcomes, including postoperative course and management were compared. Descriptive statistics and Wilcoxon rank-sum test or Fisher exact test as appropriate were used to determine significant differences.

Results: In the 14 trisomy 13/18 patients who underwent cardiac surgery, there was an increased incidence of postoperative complications. Specifically, 93% had airway or pulmonary complications, including prolonged mechanical ventilation (n = 8), prolonged noninvasive positive pressure ventilation (n = 6), re-intubation (n = 7), tracheitis/pneumonia (n = 6), and tracheostomy (n = 2). The duration of intubation was longer (7.5 vs 2 days; P < .0001) as was the duration of noninvasive positive pressure ventilation (8 vs 2 days; P < .04) with longer hospital length of stay in the trisomy 13/18 cohort. There was 1 in-hospital mortality, with none in the control group.

Conclusions: Although most trisomy 13/18 patients survive cardiac surgery, these patients have an increased incidence of airway complications, requiring longer intensive respiratory support postoperatively that contributes to longer length of stay. Parental guidance before cardiac surgery should include a discussion about postoperative airway management.