Vocal cord dysfunction after pediatric cardiac surgery: A prospective implementation study

Area of Science:

• Pediatric Cardiothoracic Surgery
• Vocal Cord Dysfunction
• Implementation Science

Background:

• Postoperative vocal cord dysfunction (VCD) is a potential complication following pediatric cardiothoracic surgery.
• Understanding its incidence, impact on patient outcomes, and diagnostic methods is crucial for effective management.

Purpose of the Study:

• To determine the incidence and outcomes of postoperative vocal cord dysfunction (VCD) in children undergoing cardiothoracic surgery.
• To evaluate diagnostic modalities for VCD in this patient population.

Main Methods:

• A prospective mixed-methods study incorporating implementation science principles.
• Patients undergoing aortic arch, ductus, ligamentum arteriosum, or vascular ring surgery were assessed using speech pathology, laryngeal ultrasound, and laryngoscopy.

Main Results:

• The incidence of VCD ranged from 18% to 56%, with higher rates after hypoplastic aortic arch repair (57%).
• VCD was associated with increased need for nasogastric feeding but did not significantly impact hospital or ICU stay.
• Combined speech pathology assessment and laryngeal ultrasound demonstrated 91% sensitivity for VCD diagnosis.

Conclusions:

• Vocal cord dysfunction (VCD) occurs in about one-third of pediatric cardiothoracic surgery patients, often resolving within three months.
• Aortic arch repair poses the highest risk for VCD, which can affect feeding.
• Speech pathology assessment and laryngeal ultrasound provide a reliable and patient-friendly diagnostic approach.