Outcomes of Neonates and Infants with Vocal Fold Mobility Impairment After Cardiac Surgery

Vocal fold mobility impairment (VFMI) due to recurrent laryngeal nerve injury is a well-described but under-recognized complication of congenital heart surgery (CHS) in pediatric patients, with significant potential additional burden of care. Neonates and infants who underwent CHS at a single center between September 1st, 2020 and June 30th, 2025 and were diagnosed with post-operative VFMI were included. Patients were classified as Clancy I through IV based on their anatomic characteristics for congenital cardiac lesions. Propensity score matching was performed to identify a subset of cardiac surgical patients without VFMI to evaluate associations between VFMI and postoperative outcomes. A total of 77 out of total 667 patients (11.5%) had VFMI. Clancy class II was most represented (n = 38, 49.4%), followed by class I (22, 28.6%), class IV (15, 19.5%), and class III (2, 2.6%). Patients with VFMI had longer median (IQR) post-operative hospital length of stay at 28 days (17-49) vs. 12 (6-30); p < 0.001) and more often required post-operative ventilation [66 (85.7%) vs. 168 (72.7%); p = 0.042] compared to those without VFMI. At discharge, fewer VFMI patients tolerated full enteral feeds 44 (57.1%) vs. 163 (80.7%) and VFMI patients had more gastrostomy tubes 15 (19.5%) vs. 14 (6.9%) and with a nasogastric tubes 17 (22.1%) vs. 24 (11.9%); p < 0.001. Intervention with vocal cord injection was not associated with differences in postoperative length of stay or incidence of successful PO feeding at discharge. These findings highlight the substantial additional clinical burden associated with VFMI in pediatric cardiac surgery patients, underscoring the importance of early recognition and multidisciplinary management.