Routine vocal cord mobility assessment post cardiac surgery via median sternotomy approach

Area of Science:

• Pediatric Cardiac Surgery
• Neonatal Care
• Otolaryngology

Background:

• Aortic arch reconstructive surgery in neonates poses a risk to adjacent vagus and recurrent laryngeal nerves.
• Vocal cord dysfunction (VCD) is a potential complication due to the anatomical proximity of these nerves to the surgical site.

Purpose of the Study:

• To investigate the incidence, symptoms, and natural history of VCD following aortic arch surgery in newborns.
• To identify risk factors and outcomes associated with VCD in this patient population.

Main Methods:

• Prospective study of newborns undergoing aortic arch surgery via median sternotomy.
• Post-operative flexible fiberoptic nasolaryngoscopy (FNL) to diagnose VCD.
• Feeding assessment by speech pathologists and video fluoroscopic swallow study (VFSS) for patients with VCD or feeding difficulties.

Main Results:

• Left-sided VCD occurred in 65.7% of 35 neonates, associated with younger age and weak cry.
• 52.5% of VCD patients showed aspiration on VFSS; VCD or weak cry increased likelihood of NG tube discharge.
• No significant difference in ICU or hospital stay between VCD and non-VCD groups.

Conclusions:

• VCD is a frequent complication post-neonatal aortic arch surgery.
• Most VCD cases resolve spontaneously over time.
• Routine post-operative laryngoscopy is recommended, particularly for neonates with a weak cry.