Evaluation of vocal cord paralysis after total arch replacement using routine laryngeal endoscopy

This study aimed to clarify the true incidence and clinical impact of left vocal cord paralysis (VCP) following total arch replacement (TAR) by implementing routine postoperative laryngoscopic evaluations.

We retrospectively analyzed 119 patients who underwent TAR at our institution between April 2015 and August 2024. Symptomatic VCP was defined as endoscopically confirmed VCP accompanied by clinical symptoms. All patients underwent routine postoperative laryngoscopic examination. The study endpoints were: (1) the incidence of left symptomatic VCP after TAR, (2) the impact of left symptomatic VCP on postoperative complications, and (3) predictors of left symptomatic VCP.

Symptomatic VCP was observed in 38 patients (31.9%), including 28 with left symptomatic VCP (23.5%). The left symptomatic VCP (+) group had a higher rate of pulmonary complications compared to the left symptomatic VCP (-) group (50.0% vs. 19.8%, p < 0.05) and tended to have longer hospital stays (median 33.5 [21.3-45.3] vs. 23.0 [18.0-35.0] days, p = 0.057). Zone 3 anastomosis was more frequently performed in the left symptomatic VCP (+) group (64.3% vs. 18.7%, p < 0.001). Multivariate logistic regression identified Zone 3 anastomosis as an independent predictor of left symptomatic VCP.

Routine laryngoscopy revealed that left symptomatic VCP after TAR is relatively common and might be associated with an increased risk of pulmonary complications. If anatomical and pathological conditions permit, avoidance of distal anastomosis in Zone 3 could help reduce the risk of left symptomatic VCP following TAR.