Open AccessVocal Cord Paralysis and Dysphagia after Aortic Arch Reconstruction and Norwood Procedure
Author(s) -
Pham Vinh,
Connelly Diana,
Wei Julie L.,
Sykes Kevin J.,
O'Brien Jim
Publication year - 2014
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599814522413
Subject(s) - medicine , norwood procedure , dysphagia , surgery , aortic arch , interquartile range , stridor , paralysis , vocal cord paralysis , gastrostomy , aorta , hypoplastic left heart syndrome , cardiology , airway , heart disease
Objectives To determine the incidence of vocal cord (VC) paralysis and dysphagia after aortic arch reconstruction, including the Norwood procedure. Setting Tertiary children's hospital. Study Design Retrospective cohort. Methods Database/chart review of neonates requiring Norwood or arch surgery between January 2005 and December 2012. Demographics, postoperative VC function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long‐term follow‐up were reviewed. Results One hundred fifty‐one consecutive subjects (96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days (interquartile range [IQR], 7‐13) for Norwood and 24 days (IQR, 12‐49) for arch reconstruction ( P <. 001). Documentation of VC motion abnormality was found in 60 of 104 (57.6%) subjects and unavailable in 47 (16 without documentation and 31 who died prior to extubation). There were no significant differences in proportions of documented VC motion ( P =. 337), dysphagia ( P =. 987), and VC paralysis ( P =. 706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without unilateral VC paralysis (UVCP), dysphagia was present (56% Norwood, 61% arch). Overall, 120 of 151 (79.5%) required feeding evaluation and a modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55 of 151 (36.4%) patients. Of those with VC paralysis, only 23 (22%) had any otolaryngology follow‐up after discharge from surgery. More than 75% with VC paralysis with follow‐up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis. Conclusion There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.