Elective Tracheotomy Facilitates Total Artificial Heart Implantation in Calves

Chronic ventilatory support may be required for survival after total artificial heart (TAH) implantation in calves. However, prolonged or repeated intubation may negatively affect a calf's ability to eat, drink, ruminate, and stand after surgery. To mitigate these limitations, we performed tracheotomies on 23 consecutive calves at the time of TAH implantation. The tracheostomies served as the primary route for ventilatory support and airway management. Tracheostomies were left in place for up to 25 days (mean, 7 +/- 7 days) and were well tolerated. Prolonged presence of a tracheostomy facilitated cleaning of the airway secretions and did not inhibit the calf's ability to stand, eat, or drink. The calves survived from 2 to 49 days (mean, 8 days). Twenty-two calves that maintained their tracheostomies died of causes unrelated to airway management. The calf that had the tracheostomy removed on day 25 died of respiratory arrest on day 49. At necropsy, we found that severe tracheal stenosis had developed at the tracheostomy site. In calves, an elective tracheotomy can be a valuable adjunct to TAH implantation or other procedures that might require prolonged ventilatory support or airway access, but care should be exercised if the tracheostomy is removed to ensure that the calf does not develop late tracheal stenosis. ASAIO Journal 2009; 55:456-458.