Tracheal Injury Complicating Mitral Valve Repair

Abstract

TRACHEAL injuries complicating cardiac surgery are extremely rare. Therefore, no guidelines exist for the management of such injuries. Tracheal injuries present unique challenges, such as endotracheal tube (ETT) positioning, adequacy of ventilation if there is an air leak, and anesthetic delivery. Although tracheal injuries during cardiac surgery are rarely reported, there are many reports of tracheal injuries from trauma or tracheal intubation, with an incidence reported as high as 0.12% after intubation with a double-lumen tube. 1 Borasio P. Ardissone F. Chiampo G. Post-intubation tracheal rupture. A report on ten cases. Eur J Cardiothorac Surg. 1997; 12: 98-100 Crossref PubMed Scopus (143) Google Scholar There are a variety of methods described in the literature for managing these injuries, including conservative management and surgical repair, both with excellent clinical outcomes. 2 Schneider T. Storz K. Dienemann H. et al. Management of iatrogenic tracheobronchial injuries: A retrospective analysis of 29 cases. Ann Thorac Surg. 2007; 83: 1960-1964 Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar Tracheal injury may be associated with significant morbidity and mortality because of increased risk of airway fire with the use of electrocautery and the risk of pneumothorax or pneumomediastinum causing cardiac tamponade or inadequate ventilation. There are special concerns regarding these injuries during cardiac surgery, including the increased risk of infection and mediastinitis secondary to contamination from tracheal secretions and bleeding from the repaired tracheal injury as a result of anticoagulation required for cardiopulmonary bypass. These complications must be weighed against the risks of delaying cardiac surgery.