Successful Primary Closure of Cricotracheostomy Fistula after Cardiac Surgery: Usefulness of Cricotracheostomy in Post-Sternotomy

TL;DR

A patient had successful recovery after cricotracheostomy following heart surgery, avoiding infection and preserving speech.

Contribution

Demonstrates cricotracheostomy as a viable option to prevent sternal wound infection and preserve vocal function after cardiac surgery.

Findings

Cricotracheostomy avoided sternal wound infection in a post-cardiac surgery patient.

The patient was successfully weaned off the ventilator and had primary closure of the cricotracheostomy fistula.

No speech or swallowing issues were observed after the procedure.

Abstract

Patients with complications requiring prolonged mechanical ventilation after cardiac surgery may need a tracheostomy. However, a high rate of sternal wound infection (SWI) after tracheostomy is concerning. Cricotracheostomy is a novel method used to achieve a higher tracheal incision than that using conventional surgical tracheostomy and is often performed by otolaryngologists in patients with anatomical abnormalities. However, it may affect speech and is generally recommended only in cases where tracheal stoma closure is not considered. In addition, its usefulness after cardiac surgery has not been fully verified.

A female patient in her 60s was admitted for acute aortic dissection with cardiac tamponade and underwent ascending aortic replacement and pulmonary artery patch formation. On POD 7, the patient was extubated. Pericardial fenestration was performed because of pericardial effusion. On POD 14, the patient was re-intubated owing to inability to expel sputum. On POD 16, a tracheostomy was performed. A cricotracheostomy was performed to avoid SWI and because of her anatomical abnormality—a low-lying larynx. No major complications, including SWI, were observed after cricotracheostomy. On POD 41, the patient was completely weaned off the ventilator. Primary closure of the cricotracheostomy fistula was performed on POD 47, and the patient had no problems with speech or swallowing.

This case highlights the usefulness of cricotracheostomy after cardiac surgery. Cricotracheostomy may be an optimal method for preventing SWI and preserving vocal function after cardiac surgery.

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