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Incidence and implication of vocal fold paresis following neonatal cardiac surgery
Author(s) -
Dewan Karuna,
Cephus Constance,
Owczarzak Vicki,
Ocampo Elena
Publication year - 2012
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.23575
Subject(s) - medicine , paresis , surgery , cardiac surgery , incidence (geometry) , median sternotomy , swallowing , retrospective cohort study , cohort , aortic arch , cardiothoracic surgery , anesthesia , aorta , physics , optics
Objectives/Hypothesis: To study the incidence and implications of vocal fold paresis (VFP) following congenital neonatal cardiac surgery. Study Design: Retrospective chart review. Methods: All neonates who underwent median sternotomy for cardiac surgery from May 2007 to May 2008 were evaluated. Flexible laryngoscopy was performed to evaluate vocal fold function after extubation. Swallow evaluation and a modified barium swallow study were performed prior to initiating oral feeding if the initial screening was abnormal. Results: A total of 101 neonates underwent cardiac surgery during the study period. Ninety‐four patients underwent a median sternotomy, and 76 of these were included in the study. Fifteen (19.7%) had vocal fold paresis (VFP) postoperatively. Almost 27% of the patients with aortic arch surgery had VFP while only 4.1% of the patients with nonaortic arch surgery developed VFP (P=0.02) Those patients who underwent aortic arch surgery weighed significantly less (P<0.01). All the patients with VFP had significant morbidity related to swallowing and nutrition (P=0.01) and required longer postsurgical hospitalization (P=0.02). Conclusions: The reported incidence of VFP following cardiac surgery via median sternotomy ranges between 1.7% and 67% depending on the type of surgery and the weight of the infant at the time of surgery. In our cohort, 19.7% had VFP. Surgery requiring aortic arch manipulation had a higher incidence of complications and required longer hospitalizations. These results may be used to improve informed consent and to manage postoperative expectations by identifying patients who are at higher risk for complications.