Postoperative Vocal Fold Immobility in Pediatric Patients Undergoing Pulmonary Artery Reconstruction Surgery

Children undergoing pulmonary artery (PA) reconstruction for PA stenosis or major aortopulmonary collaterals are at risk for vocal fold immobility (VFI), but incidence and risk factors are poorly understood.

We analyzed risk factors for and outcomes of VFI in patients undergoing PA reconstruction surgery between 2018 and 2024 using a 2:1 case-control design.

Of 488 eligible patients, 80 (16%) were diagnosed with new postoperative VFI. Demographic and operative details were similar between cases and randomly selected controls. Significant risk factors for VFI included multiple prior cardiac surgeries and presence of distal PA branch stents. Right aortic arch, diagnosis of tetralogy of Fallot, and presence of major aortopulmonary collaterals were risk factors for right-sided VFI. Case patients had longer postoperative stays in the hospital (20 vs 14 days; P = .002) and intensive care unit (12 vs 10 days; P = .046). Although injection laryngoplasty frequently improved symptoms, more case patients than controls were discharged with an enteral feeding tube (64% vs 33%; P < .001). At 1-year follow up, 54% of case patients remained dependent on tube feeds vs 16% of controls.

Patients undergoing PA reconstruction surgery are at risk for VFI, with risk factors related to complex mediastinal disease and abnormal or variable recurrent laryngeal nerve anatomy. Although injection laryngoplasty appeared to be beneficial, patients with VFI frequently required tube feeding after hospital discharge. These findings will help with preoperative counseling and anticipatory management after PA reconstruction surgery.