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Incidence and Treatment Outcomes of Vocal Fold Movement Impairment After Total Arch Replacement
Author(s) -
Fullmer Tanner,
Wang David C.,
Price Matt D.,
LeMaire Scott A.,
Coselli Joseph S.,
Gregorio Casar J.,
Donovan Donald T.,
Eddie Liou N.,
Ongkasuwan Julina
Publication year - 2019
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.27347
Subject(s) - medicine , incidence (geometry) , surgery , intensive care unit , laryngoscopy , retrospective cohort study , arch , cohort , anesthesia , intubation , physics , optics , civil engineering , engineering
Background Vocal fold movement impairment (VFMI) secondary to neuronal injury is a known risk after aortic surgery. Total arch replacement is technically challenging, and the incidence of vocal fold movement impairment secondary to neuronal injury after this surgery is unknown. This study examined the incidence of VFMI after total arch replacement and medialization treatment outcomes. Study Design Retrospective cohort study. Methods All patients who underwent total arch replacement at a tertiary care center over 11 years (2006–2017) were identified through an institutional database. End points included evidence of VFMI on flexible laryngoscopy, time to diagnosis, time to treatment, need for reintubation, and intensive care unit (ICU) and hospital length of stay. Results Of the 358 patients who underwent total arch replacement, 63 (20%) were diagnosed with VFMI during their initial inpatient stay. Fifty patients (79%) VFMIs were left‐sided, nine (14%) were right‐sided, and four (6%) were bilateral. Thirty‐nine patients (62%) underwent inpatient vocal fold medialization: 28 (72%) by injection laryngoplasty and 11 (28%) by type 1 thyroplasty. Those with unilateral VFMI had longer ICU (8.9 days) and hospital (19.4 days) than those with no VFMI (5.7 and 16.1 days). Among patients with unilateral VFMI, those who underwent inpatient vocal fold medialization trended toward shorter ICU (6.2 vs. 14.4 days, P = .03) and hospital stays (20.1 vs. 23.3 days, P = .4) than patients who did not have a medialization procedure. Conclusion The overall incidence of VFMI after total arch replacement in our series was 20%. Both the right and left vocal folds are potentially at risk from a total arch replacement; consequently, the distribution of injury in our cohort was more heterogeneous than in other series. Level of Evidence 3 Laryngoscope , 129:699–703, 2019