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Bandi RH, Hood RR. Tracheal Injury Complicating Mitral Valve Repair. J Cardiothorac Vasc Anesth 2019; 34:1582-1585. [PMID: 31852596 DOI: 10.1053/j.jvca.2019.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Rachel H Bandi
- Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Ryan R Hood
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Henley MD, Kumar PA. Tracheal Injury Prior to Sternotomy: A Cautionary Tale. Semin Cardiothorac Vasc Anesth 2019; 23:319-323. [DOI: 10.1177/1089253218825443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tracheal laceration during cardiac surgery is a rarely reported form of iatrogenic tracheal injury. During dissection prior to sternotomy, the interclavicular ligament must be divided. This structure overlies the proximal trachea, predisposing the trachea to injury at this location. Challenges related to tracheal laceration in cardiac surgery include patients with already tenuous cardiopulmonary status, surgical positioning that increases the risk of injury, obscured traditional clinical findings causing delayed recognition, increased risk of mediastinitis, and a heightened risk of airway fire. The incidence, mechanism, and ideal management of sternotomy-related tracheal injury, though a life-threatening complication, is rarely described in the literature. Consensus is lacking regarding the necessity and timing of tracheal repair versus conservative management, whether to proceed with the initially planned procedure, and the optimal timing of airway exchange in the event of endotracheal tube cuff rupture. In this article, we present the management of a full-thickness thermal tracheal injury due to electrocautery, resulting in a large air leak treated with delayed endotracheal tube exchange and tracheal repair after cardiopulmonary bypass.
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Affiliation(s)
| | - Priya A. Kumar
- University of North Carolina at Chapel Hill, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
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Takeshita J, Nishiyama K, Fukumoto A, Ohira S, Beppu S, Sasahashi N, Shime N. Tracheal injury detected immediately after median sternotomy by inexperienced surgeons: two case reports. J Med Case Rep 2018; 12:49. [PMID: 29482594 PMCID: PMC5828137 DOI: 10.1186/s13256-018-1591-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Although median sternotomy is standard during cardiac surgery, the procedure is associated with a risk of injury to mediastinal organs. Here, we discuss two cases of tracheal injury following median sternotomy during cardiac surgery. Case presentation Ventilation failure occurred in a 78-year-old Japanese man and a 71-year-old Japanese man after median sternotomy, and tracheal injury was identified. The sites of injury were directly repaired and covered with mediastinal fat tissue, following which ventilation was successful. The burn-like deposits observed at the site of tracheal injury and on the removed endotracheal tube support the notion that the injuries in our patients were caused by electrocautery prior to median sternotomy. In one case, short sternotracheal distance may have contributed to tracheal injury during post-sternal manipulation. In both cases, the relative inexperience of both surgeons also supports the suspected cause of injury. Conclusions Tracheal injury represents a potential complication following median sternotomy, especially when performed by inexperienced surgeons or in cases of short sternotracheal distance. Anesthesiologists should consider this rare yet potentially lethal complication.
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Affiliation(s)
- Jun Takeshita
- Department of Intensive Care Medicine, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan.
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Atsushi Fukumoto
- Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, 2 Otowachinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA, 19107, USA
| | - Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nozomu Sasahashi
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Kayatta MO, Vasquez JC, DeLaRosa J. Conservative management of intraoperative tracheal injury during cardiac operations. Ann Thorac Surg 2014; 97:1425-7. [PMID: 24694420 DOI: 10.1016/j.athoracsur.2013.07.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/25/2013] [Accepted: 07/01/2013] [Indexed: 01/07/2023]
Abstract
Iatrogenic intraoperative tracheal injuries are rare in cardiac operations. Management of this complication is not well described because of the low incidence and lack of reported cases. We present an 82-year-old woman who sustained a tracheal injury during aortic valve replacement. Soft tissue coverage of the trachea was obtained, the original cardiac operation was completed, and she was otherwise managed conservatively. She recovered without further complication and was discharged home 1 week after the surgical procedure.
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Affiliation(s)
- Michael O Kayatta
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Julio C Vasquez
- Division of Thoracic and Cardiovascular Surgery, Portneuf Medical Center, Pocatello, Idaho
| | - Jacob DeLaRosa
- Division of Thoracic and Cardiovascular Surgery, Portneuf Medical Center, Pocatello, Idaho.
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Raut M, Maheshwari A, Shivnani G, Daniel E, Sharma S, Rohra G. Anterior Tracheal Injury During Sternotomy. J Cardiothorac Vasc Anesth 2013; 27:e60-1. [DOI: 10.1053/j.jvca.2013.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Indexed: 11/11/2022]
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Gosnell JE, Campbell P, Sidhu S, Sywak M, Reeve TS, Delbridge LW. Inadvertent tracheal perforation during thyroidectomy. Br J Surg 2006; 93:55-6. [PMID: 16278924 DOI: 10.1002/bjs.5136] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Valuable advice for thyroid surgeons
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Affiliation(s)
- J E Gosnell
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Okada S, Ishimori S, Yamagata S, Satoh S, Tanaba Y, Yaegashi S. Videobronchoscope-assisted repair of the membranous tracheal laceration during insertion of a tracheostomy tube after tracheostomy. J Thorac Cardiovasc Surg 2002; 124:837-8. [PMID: 12324745 DOI: 10.1067/mtc.2002.126044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Shinichiro Okada
- Department of Thoracic Surgery and Medicine, Kamaishi Municipal Hospital, 3-15-26 Ohwatari-cho, Kamaishi, Iwate 026-0025, Japan.
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