Outcomes of Vocal Fold Motion Impairment and Dysphagia after Pediatric Cardiothoracic Surgery: A Systematic Review

Abstract

Objective The objective of this study was to systematically review the literature regarding vocal fold motion impairment (VFMI), respiratory outcomes, and swallowing outcomes in children following congenital heart surgery (CHS). Data Sources PubMed, Embase, Medline, and CINAHL databases. Review Methods Data sources were searched from inception to November 30, 2018. Studies that described recovery of VFMI and swallowing function following CHS were included, and a qualitative analysis was performed. Results A total of 1371 studies were identified, of which 8 met inclusion criteria for VFMI and 5 met inclusion criteria for swallowing outcomes. Studies including patients who underwent isolate patent ductus arteriosus ligation were excluded. VFMI was present in 8% to 59% of subjects, and rates of recovery ranged from 9% to 96% at 6 months to 6 years of follow-up. Inability to maintain an oral diet occurred in 14% to 100% of subjects with VFMI and 11% to 61% without VFMI following surgery. Tolerance of an oral diet without tube feeding was present in 66% to 75% of subjects with VFMI and 88% to 100% without VFMI at 24 days to 3.2 years of follow-up. Limited data suggest that time to extubation is longer in VFMI subjects, but overall hospital length of stay and mortality may not be affected by VFMI status. Conclusions Data evaluating dysphagia and VFMI after CHS are limited. Most studies suggest significant improvement in swallowing function, while rate of recovery of VFMI is variable. Future prospective studies with standardized screening and follow-up are needed to better elucidate outcomes to help develop algorithms for identification and management of VFMI after CHS.

RETRACTED ARTICLE: The effect of early oral stimulation with breast milk on the feeding behavior of infants after congenital cardiac surgery

“…Many infants with CHD require prolonged endotracheal intubation and mechanically assisted ventilation after cardiac surgery, and some of them have varying degrees of difficulty with feeding. According to a literature search, many researchers have adopted various strategies to improve oral motor function in postoperative children with feeding disorders [13,14]. Some researchers applied nonnutritive pacifier sucking strategies when the children were in a fasting period to accelerate the maturation of sucking reflexes.…”

Vocal Fold Movement and Silent Aspiration After Congenital Heart Surgery

“…As a result, infants undergoing these procedures are at risk of both vocal fold motion impairment (VFMI) and swallowing difficulties. 2 Some of the most common surgical procedures performed include patent ductus arteriosus ligation, ventricular septal defect or atrial septal defect repair, aortic arch repair, tetralogy of Fallot repair, coarctation repair, total anomalous pulmonary venous return repair, and stage 1 palliation, also known as the Norwood procedure. Surgical procedures may be done in isolation or in combination.…”

“…8,9 In addition, RLN injury resulting in VFMI has been reported in up to 59% of infants after congenital heart surgery. 2 VFMI is known to contribute to feeding difficulties and aspiration, and therefore postoperative vocal fold evaluation can be helpful for planning therapeutic and compensatory strategies. 2,10,11 Although previous studies have shown that VFMI after congenital heart surgery leads to a heightened risk of swallowing difficulties, it is notable that those without VFMI are still prone to dysphagia and silent aspiration.…”

“…2 VFMI is known to contribute to feeding difficulties and aspiration, and therefore postoperative vocal fold evaluation can be helpful for planning therapeutic and compensatory strategies. 2,10,11 Although previous studies have shown that VFMI after congenital heart surgery leads to a heightened risk of swallowing difficulties, it is notable that those without VFMI are still prone to dysphagia and silent aspiration. 5,12 The purpose of this study is to: 1) describe dysphagia and airway protection using videofluoroscopic swallow study (VFSS) data in infants who underwent congenital heart surgery; 2) determine whether the complexity of surgery, as defined by the STAT categories, can predict swallowing abnormalities; 3) quantify the impact of VFMI on swallowing abnormalities, in particular silent aspiration.…”

Ultrasound of the vocal cords in infants

“…Direct injury to the nerve through mechanical or energy transmission are more likely to be long-standing, though functional recovery through compensation can occur. A recent systematic review suggested that swallow function in children with vocal cord paralysis after cardiovascular surgery tends to improve but the rate of recovery of nerve function is variable [6]. Aortic arch reconstruction in hypoplastic left heart syndrome, prematurity and low birthweight at the time of procedure are poor prognostic factors for spontaneous recovery [7,8].…”