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Vocal cord paralysis after cardiovascular surgery in children: incidence, risk factors and diagnostic options
Enrique García-Torres1, Juan L Antón-Pacheco2, Mª Carmen Luna-Paredes3
1Pediatric Cardiovascular Surgery Unit, Pediatric Institute of the Heart, Hospital Universitario 12 de Octubre, Madrid, Spain.
Insights
Vocal cord paralysis (VCP) affects 12.1% of children post-cardiovascular surgery. Comorbidities and lower weight at surgery significantly increase VCP risk, with laryngeal ultrasound showing diagnostic utility.
Area of Science:
- Pediatric Surgery
- Cardiology
- Otolaryngology
Background:
- Vocal cord paralysis (VCP) is a potential complication following pediatric cardiovascular surgery.
- Identifying risk factors and diagnostic methods for VCP is crucial for patient management.
Purpose of the Study:
- To determine the incidence of VCP in children after cardiovascular surgery.
- To identify factors associated with VCP development.
- To evaluate the diagnostic value of laryngeal ultrasound (US) for VCP.
Main Methods:
- Retrospective review of 206 pediatric patients undergoing cardiovascular surgery (2007-2017).
- Data collected included demographics, comorbidities, surgical details, and VCP diagnosis via laryngoscopy and laryngeal US.
- Univariable and multivariable logistic regression analyses were performed to identify VCP risk factors.
Main Results:
- VCP was detected in 12.1% of patients post-surgery.
- Significant risk factors for VCP on multivariable analysis included the presence of comorbidities and lower weight at surgery.
- Laryngeal US demonstrated an excellent diagnostic relationship in the cases it was performed.
Conclusions:
- VCP is a notable complication in pediatric cardiovascular surgery.
- Comorbidities and perioperative weight are significant predictors of VCP.
- Laryngeal ultrasound is a valuable complementary diagnostic tool for VCP.
Objectives:
The aim of this study was to assess the incidence of vocal cord paralysis (VCP) in children after cardiovascular surgery. The secondary aims were to identify the factors potentially associated with VCP and to assess the diagnostic utility of laryngeal ultrasound (US).
Methods:
This study is a retrospective review of patients who underwent aortic repair, patent ductus arteriosus ligation and left pulmonary artery surgeries from 2007 to 2017. The following data were collected: patient demographics, gestational age, weight and age at surgery, comorbidities, cardiovascular anomaly and type of procedure, laryngoscopic and US evaluation results. Univariable and multivariable logistic regression models were used to identify the variables associated with VCP.
Results:
Two hundred and six patients were included in the study. Seventy-two patients (35%) were preterm and 32.5% showed comorbidities. At surgery, median age and weight were 0.6 months [interquartile range (IQR) 0.3-2.1] and 3.0 kg (IQR 1.3-4.0), respectively. Postoperatively, symptomatic patients underwent endoscopic evaluation and VCP was detected in 25 cases (12.1%). Laryngeal US was performed in 8 of these showing an excellent diagnostic relationship. On univariable analysis, factors significantly associated with VCP were prematurity, young age and lower weight at surgery and the presence of comorbidities. The presence of comorbidities and weight at surgery exhibited a significant risk of developing VCP postoperatively on multivariable analysis.
Conclusions:
VCP is not an unusual complication of cardiovascular surgery. Certain factors were associated with VCP development but only the presence of comorbidities and weight at surgery were statistically significant on multivariable analysis. Flexible laryngoscopy is the standard diagnostic technique and laryngeal US appears to be a reliable complement.
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