Our Summary

This research paper discusses a rare type of injury that can occur during heart surgery, specifically damage to the trachea (the tube that carries air to and from the lungs). This injury can happen while the surgeon is preparing for the operation and needs to cut a ligament that is located above the trachea. Unfortunately, this has the potential to cause harm to the trachea.

This type of injury presents a number of challenges. Patients undergoing heart surgery often already have weakened heart and lung function, and their positioning during surgery can increase the risk of injury. Additionally, the signs of this injury are often hidden, which can lead to a delay in recognizing the problem. There’s also a higher risk of infection and even the possibility of a fire in the airway.

Despite the serious nature of this complication, there isn’t much information available on the frequency, causes, and best ways to manage this type of trachea injury. The medical community also has not reached a consensus on when and how to repair the trachea, whether to continue with the planned procedure, and when to change the airway tube if it’s damaged during surgery.

In this article, the authors describe how they managed a severe injury to the trachea that was caused by an electrocautery tool (a surgical instrument that uses heat to stop bleeding or to cut through tissue). They treated the patient with a delayed change of the airway tube and repair of the trachea after the heart-lung machine was no longer needed.

FAQs

  1. What is the risk of tracheal laceration during cardiac surgery?
  2. What are the challenges associated with tracheal laceration in cardiac surgery?
  3. How is a full-thickness thermal tracheal injury managed during cardiac surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sternotomy is to be aware of the potential risk of tracheal injury during the procedure. It is important for patients to follow post-operative instructions carefully, including avoiding activities that could strain the chest or neck area, such as heavy lifting or strenuous exercise. If any symptoms such as difficulty breathing, chest pain, or persistent coughing occur, it is important to seek medical attention promptly. Regular follow-up appointments with the healthcare provider are also important to monitor for any potential complications.

Suitable For

Patients who are typically recommended sternotomy include those who require cardiac surgery, such as coronary artery bypass grafting, valve replacement, or repair of congenital heart defects. These patients may have conditions such as coronary artery disease, valvular heart disease, or structural heart abnormalities that necessitate surgical intervention. Additionally, patients with aortic dissection or thoracic aortic aneurysms may also undergo sternotomy for surgical repair. It is important to note that sternotomy is a major surgical procedure and is usually reserved for patients with serious or life-threatening cardiac conditions.

Timeline

Before sternotomy:

  • Patient undergoes preoperative evaluation and preparation for cardiac surgery
  • Patient is positioned on the operating table and anesthesia is induced
  • Surgical team prepares the patient for sternotomy by marking the incision site and prepping the area
  • Dissection is performed to access the heart and great vessels, including division of the interclavicular ligament
  • Trachea is at risk of injury during this dissection due to its proximity to the ligament

After sternotomy:

  • Patient undergoes sternotomy to access the heart and perform the necessary cardiac surgery
  • Tracheal injury occurs during the dissection, resulting in a full-thickness thermal injury due to electrocautery
  • Patient experiences a large air leak from the tracheal injury, which requires management
  • Decision is made to delay endotracheal tube exchange and repair the tracheal injury after cardiopulmonary bypass
  • Surgical team performs tracheal repair and addresses any complications related to the injury
  • Patient is monitored closely postoperatively for any signs of infection, airway compromise, or other complications from the tracheal injury.

What to Ask Your Doctor

  1. What are the potential risks and complications of sternotomy, including tracheal injury?
  2. How can tracheal injury during sternotomy be diagnosed and managed?
  3. What is the incidence of tracheal injury during sternotomy, and what are the factors that may increase the risk of this complication?
  4. What is the standard protocol for managing tracheal lacerations during cardiac surgery, and how does it differ from other types of tracheal injuries?
  5. How will tracheal injury impact the overall surgical procedure and recovery process?
  6. What is the expected outcome and prognosis for patients who experience tracheal injury during sternotomy?
  7. Are there any specific post-operative care instructions or precautions that should be followed to prevent further complications related to tracheal injury?
  8. What is the likelihood of long-term complications or issues related to tracheal injury following sternotomy?
  9. Are there any alternative treatment options or approaches that can be considered for managing tracheal injury during cardiac surgery?
  10. How can patients be proactive in monitoring and addressing any concerns related to tracheal injury during the recovery process?

Reference

Authors: Henley MD, Kumar PA. Journal: Semin Cardiothorac Vasc Anesth. 2019 Sep;23(3):319-323. doi: 10.1177/1089253218825443. Epub 2019 Feb 1. PMID: 30709327