Background and aim of the study: A regular post-cardiac surgery course does not require a prolonged stay in the cardiac surgery intensive care unit (ICU). However, a complicated postoperative period, can lead to prolonged ICU stay and prolonged ventilation, and may require a tracheostomy. Nonetheless, there is currently no consensus regarding the proper timing of tracheostomy. Data regarding long-term outcomes of early versus late tracheostomy are limited. This study represents the largest single-center experience with post-cardiac surgery tracheostomy. The aim of this study was to assess the timing of tracheostomy as a risk factor for mortality. Methods : This is a retrospective study of prospectively collected data. Patients were divided into three groups according to the timing of tracheostomy; early (4-10 days); intermediate (11-20 days) and late (≤21 days). The primary outcomes were early, intermediate, and long-term mortality. For statistical analysis we use multivariable Cox proportional hazards model. Results : Between 09.2004 and 08.2021, 12,782 patients underwent cardiac surgery at our institution, of whom 407 (3.18%) required postoperative tracheostomy. 147 (36.1%) had early, 195 (47.9%) intermediate and 65 (16%) late tracheostomy. The three groups were similar regarding their baseline characteristics and operative data. Early, 30-day and in-hospital mortality was similar for all groups. However, patients, who underwent early- and intermediate tracheostomy, demonstrating statistically significant lower mortality after 1- and 5-year (42.8%; 57.4%; 64.6%; and 55.8%; 68.7%; 75.4%, respectively; p<0.001). In our patient’s cohort Cox model show age [1.025 (1.014-1.036)] and time to tracheostomy [0.315 (0.159-0.757)] as significant factor for mortality. Conclusions : This study demonstrates a relationship between the timing of tracheostomy after cardiac surgery and mortality: early tracheostomy within 4-10 days of mechanical ventilation associated with better intermediate- and long-term survival. Short-term mortality does not seem to be affected by the timing of tracheostomy. Optimal timing of tracheostomy requires further evaluation.

Introduction: Cardiac surgery for structural heart disease in the presence of cardiogenic shock or advanced heart failure has poor outcomes. We applied venoarterial extracorporeal membrane oxygenation (ECMO) to restore end-organ function and resuscitate patients prior to high-risk cardiac surgery. Methods: During a 2-year period (1/2018-12/2019) we reviewed all patients admitted to our Medical Centre with structural heart disease and cardiogenic shock, who had been resuscitated preoperatively by ECMO. Of these patients, 11 were included in the study. Patients were placed on ECMO preoperatively for 69 hours (range, 36-136 hours). Eight patients underwent valvular surgeries and 3 patients had ventricular septal defect repairs. Results: Mean age was 54± 15 years. Nine patients presented with cardiogenic shock, and two with advanced heart failure. Nine patients needed inotropes and four needed IABP support. Seven patients were admitted with acute kidney injury and five presented with metabolic acidosis. Average calculated EUROSCORE I was 56±23% and mean calculated APACHE II score was 17.18±6.26. The mean ECMO total time was 126±93 hours. Of the four postoperative deaths, three died within 10 days of surgery and one 2 months post-surgery. Conclusion: ECMO can be used as a bridge to heart valve or septal defect surgery in severely decompensated patients suffering from cardiogenic shock. Through recovery of end-organ function, ECMO may facilitate surgical correction of structural heart disease in patients in a very high risk for surgery.