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Current Epidemiology of Vocal Cord Dysfunction After Congenital Heart Surgery in Young Infants

Gorantla, Siddharth C. BS1; Chan, Titus MD, MS, MPP2; Shen, Irving MD3; Wilkes, Jacob BS4; Bratton, Susan L. MD, MPH5

Pediatric Critical Care Medicine: September 2019 - Volume 20 - Issue 9 - p 817-825
doi: 10.1097/PCC.0000000000002010
Cardiac Intensive Care

Objectives: Surgery of the aortic arch poses risk of recurrent laryngeal nerve injury due to the anatomic proximity and can manifest as vocal cord dysfunction after surgery. We assessed risk factors for vocal cord dysfunction and calculated surgical procedure associated rates in young infants after congenital heart surgery.

Design: Cross section analysis.

Setting: Forty-four children’s hospitals reporting administrative data to Pediatric Health Information System.

Participants: Cardiac surgical patients less than or equal to 90 days old and discharged between January 2004 and June 2014.

Interventions: None.

Measurements and Main Results: Overall, 2,319 of 46,567 subjects (5%) had vocal cord dysfunction, increasing from 4% to 7% over the study period. Of those with vocal cord dysfunction, 75% had unilateral partial paralysis. Vocal cord dysfunction was significantly more common in newborn infants (74%), those with aortic arch procedures (77%) and with greater surgical complexity. Rates of vocal cord dysfunction ranged from 0.7% to 22.4% across surgical procedure groups. Vocal cord dysfunction was significantly associated with greater use of: prolonged mechanical ventilation (53% vs 40%), diaphragmatic plication (3% vs 1%), feeding tube use (32% vs 8%), surgical airways (4% vs 2%), and prolonged length of stay (44 vs 21 d). Vocal cord dysfunction testing increased significantly over the study (6–14 %), and vocal cord dysfunction diagnosis increased almost two-fold (odds ratio, 1.9; 95% CI, 1.7–2.1) comparing the last to first study quarters with the increase in vocal cord dysfunction diagnosis occurring predominately in surgeries to the aortic arch supported by cardiopulmonary bypass. However, aortic procedures without cardiopulmonary bypass and nonaortic arch procedures were common surgeries accounting for 27% and 23% of vocal cord dysfunction cases despite low overall vocal cord dysfunction rates (3.7% and 2.6%).

Conclusions: Vocal cord dysfunction complicated all cardiac surgical procedures among infants including those without aortic arch involvement. Increased efforts to determine appropriate indications for prevention, screening and treatment of vocal cord dysfunction among young infants after congenital heart surgery are needed.

1Rice University College of Natural Sciences, Houston, TX.

2Division of Pediatric Critical Care, Pediatrics Department, University of Washington School of Medicine, Seattle, WA.

3Division of Cardiothoracic Surgery, Surgery Department, Oregon Health and Science University, Portland, OR.

4Pediatric Clinical Program, Intermountain Health Care, Salt Lake City, UT.

5Division of Pediatric Critical Care, Pediatrics Department, University of Utah, School of Medicine, Salt Lake City, UT.

This work was performed at the University of Utah.

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The authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies