Vocal Cord Paralysis After Thoracic Aortic Surgery: Incidence and Impact on Clinical Outcomes

Lodewyks, Carly; White, Christopher W.; Bay, Graham H.; Hiebert, Brett; Wu, B.; Barker, M.; Kirkpatrick, Iain D.C.; Arora, Rakesh C.; Moon, Michael; Pascoe, Edward

doi:10.1016/j.athoracsur.2015.02.021

Cited by 32 publications

(34 citation statements)

References 8 publications

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“…Thus, the incidence varies, with reported values ranging from 0.67 to 23% for all types of thoracic cardiovascularprocedures 1,2,11,12 and from 7.3 to 32.3% for aortic arch surgery; 3,13 our incidences of 3.9 and 9.9%, respectively, are within these previously reported ranges.…”

Section: Discussionsupporting

confidence: 81%

“…1–3 Clinical symptoms of VCP include a characteristic breathy voice that is often accompanied by swallowing disabilities, shortness of breath and inefficient throat clearing which may cause aspiration and recurrent pneumonia. 1 The degree of VCP-related obstructive symptoms varies; however, in severe cases, stridor and airway obstruction may occur, resulting in extubation failure.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Taenaka

Shibata²,

Okitsu³

et al. 2017

European Journal of Anaesthesiology

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BACKGROUNDVocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur.OBJECTIVETo evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors.DESIGNSingle-centre retrospective review of adult patients.SETTINGOsaka University Hospital, Suita, Japan, from January 2013 to August 2015.PATIENTSWe included 688 patients in the final analysis. Preoperative, intraoperative and postoperative data were collected from medical records. Patients with preoperative VCP or tracheostomy prior to extubation were excluded. The VCP severity in relation to functional recovery was graded using the following categories: absent; mild, remission at 6 months; moderate, partial or persistent VCP at 6 months; or severe, airway obstruction after extubation requiring reintubation. An otolaryngologist diagnosed all VCP cases.MAIN OUTCOME MEASURESThe incidence and severity of VCP after extubation.RESULTSThe incidence (number) of VCP was 4.7% (32), with those of mild, moderate and severe VCP being 1.7% (12), 1.5% (10) and 1.5% (10), respectively. The ICU stay was significantly longer in patients with severe VCP than in patients without VCP [12.5 days (interquartile range 5.5 to 25.5) vs. 3 days (interquartile range 2 to 5), P = 0.0002]. In our multivariable analysis, type 2 diabetes mellitus [odds ratio (OR) 1.853, P = 0.009], intubation period (OR per 24 h 1.136, P = 0.014), ascending aortic arch surgery with brachiocephalic artery reconstruction (OR 8.708, P < 0.001) and ventricular assist device implantation (OR 3.460, P = 0.005) were independent predictors for VCP.CONCLUSIONThe identification of these risk factors may facilitate screening for VCP before extubation and possibly help anaesthesia personnel to be prepared to treat VCP-related airway obstruction should it occur.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Taenaka

Shibata²,

Okitsu³

et al. 2017

European Journal of Anaesthesiology

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“…The incidence of lower respiratory tract infections within 2 years of LTx was similar in both groups. In a cohort undergoing a thoracic aortic procedure with postoperative VCP, a strikingly high incidence of pneumonia (58% vs. 17% of matched controls) was reported . We could not find a similarly increased risk in our cohort, but the postoperative regimens especially regarding anti‐infective prophylaxis are incomparable in LTx recipients.…”

Section: Discussioncontrasting

confidence: 61%

Risk factors and outcomes of vocal cord paralysis after lung transplantation - a retrospective cohort study

et al. 2019

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Summary Vocal cord paralysis (VCP) may complicate thoracic surgery and is associated with increased morbidity and mortality. Among lung transplant (LTx) recipients, chronic pulmonary aspiration can contribute to chronic allograft dysfunction (CLAD). We herein assessed the unknown incidence and clinical impact of VCP in a large LTx cohort. All first‐time bilateral LTx recipients, transplanted between January 2010 and June 2015 were included in a single‐centre retrospective analysis. Bronchoscopy reports were assessed for VCP. Patients exhibiting VCP were compared to propensity score‐matched negative controls regarding CLAD onset and graft survival and secondary end‐points, including inpatient duration and complications; lower respiratory tract infections (LRTI) within 24 months. In total, 583/713 (82%) patients were included in the analysis. A total of 52 (8.9%) exhibited VCP, which was transient in 34/52 patients (65%), recovering after median 6 months (IQR 2–12). Compared to 268 controls, 3‐year graft survival and CLAD‐free survival were non‐inferior in VCP [HR 0.74 (95% CI 0.35–1.57), and HR 0.74 (95% CI 0.39–1.41)] respectively. Duration of hospitalization was similar and no differences in LRTI rates or airway complications were observed. Lower pre‐Tx BMI increased risk for VCP [HR 0.88 (95% CI 0.79–0.99)]. Overall, VCP did not adversely affect graft and CLAD‐free survival and secondary outcomes including LRTIs and hospitalizations.

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“…16 In addition, recurrent laryngeal nerve injury occurs in 25% to 50% of patients during TAAA repairs, likely secondary to proximal aortic surgical dissection or clamping. 22 By using a stage 1 TEVAR, this component of the TAAA repair is eliminated, thereby simplifying the operation.…”

Section: Discussionmentioning

confidence: 99%

Staged hybrid repair of extensive thoracoabdominal aortic aneurysms secondary to chronic aortic dissection

Jain

Flohr

Johnston

et al. 2016

Journal of Vascular Surgery

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Vocal Cord Paralysis After Thoracic Aortic Surgery: Incidence and Impact on Clinical Outcomes

Cited by 32 publications

References 8 publications

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Risk factors and outcomes of vocal cord paralysis after lung transplantation - a retrospective cohort study

Staged hybrid repair of extensive thoracoabdominal aortic aneurysms secondary to chronic aortic dissection

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