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

Siddharth C Gorantla¹, Titus Chan², Irving Shen³

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

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

|June 28, 2019

Insights

Vocal cord dysfunction (VCD) affects 5% of infants undergoing congenital heart surgery, with higher rates in newborns and those with aortic arch procedures. Further research is needed for prevention and treatment strategies.

Area of Science:

Pediatric Cardiology
Pediatric Surgery
Otolaryngology

Background:

Surgery of the aortic arch is associated with recurrent laryngeal nerve injury.
Vocal cord dysfunction (VCD) can manifest after cardiac surgery in infants.
Understanding risk factors and rates of VCD is crucial for improving patient outcomes.

Purpose of the Study:

To assess risk factors for vocal cord dysfunction (VCD) in infants undergoing congenital heart surgery.
To calculate surgical procedure-associated rates of VCD.
To identify trends in VCD diagnosis and testing over time.

Main Methods:

Cross-sectional analysis of administrative data from 44 children's hospitals.
Inclusion of cardiac surgical patients aged 90 days or younger.
Data collected between January 2004 and June 2014.

Main Results:

Vocal cord dysfunction (VCD) occurred in 5% of 46,567 subjects, increasing from 4% to 7% over the study period.
VCD was more common in newborns (74%) and infants undergoing aortic arch procedures (77%).
Rates of VCD varied widely (0.7%–22.4%) across procedure groups and were associated with prolonged ventilation, feeding tube use, and longer hospital stays.

Conclusions:

Vocal cord dysfunction (VCD) complicates various infant cardiac surgeries, not limited to aortic arch procedures.
Increased efforts are needed for the prevention, screening, and treatment of VCD in infants post-congenital heart surgery.

Read full analysis

Abstract

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.

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