Vocal Fold Movement and Silent Aspiration After Congenital Heart Surgery

Abstract

Objectives/Hypothesis: Infants who undergo congenital heart surgery are at risk of developing vocal fold motion impairment (VFMI) and swallowing difficulties. This study aims to describe the dysphagia in this population and explore the associations between surgical complexity and vocal fold mobility with dysphagia and airway protection.Study Design: Retrospective chart review. Methods: This is a retrospective chart review of infants (age <12 months) who underwent congenital heart surgery between 7/2008 and 1/2018 and received a subsequent videofluoroscopic swallow study (VFSS). Demographic information, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category of each surgery, vocal fold mobility status, and VFSS findings were collected and analyzed.Results: Three hundred and seventy-four patients were included in the study. Fifty-four percent of patients were male, 24% were premature, and the average age at the time of VFSS was 59 days. Sixty percent of patients had oral dysphagia and 64% of patients had pharyngeal dysphagia. Fifty-one percent of patients had laryngeal penetration and 45% had tracheal aspiration. Seventy-three percent of these aspirations were silent. There was no association between surgical complexity, as defined by the STAT category, and dysphagia or airway protection findings. Patients with VFMI after surgery were more likely to have silent aspiration (odds ratio = 1.94, P < .01), even when adjusting for other risk factors.Conclusion: Infants who undergo congenital heart surgery are at high risk for VFMI and aspiration across all five STAT categories. This study demonstrates the high prevalence of silent aspiration in this population and the need for thorough postoperative swallow evaluation.

Prevalence and Risk Factors for Tube-Feeding at Discharge in Infants following Early Congenital Heart Disease Surgery: A Single-Center Cohort Study

“…14 However, some studies did not observe a correlation between the categories on RACHS/STAT and the oral feeding outcomes in newborns and infants. 14,28 Variability of postsurgery complications such as vocal fold paralysis and vocal fold mobility impairment secondary to recurrent laryngeal nerve injury may be contributing this discrepancy. 25,28,29,39,40 A study that assessed the swallowing dysfunction using Modified…”

“…14,28 Variability of postsurgery complications such as vocal fold paralysis and vocal fold mobility impairment secondary to recurrent laryngeal nerve injury may be contributing this discrepancy. 25,28,29,39,40 A study that assessed the swallowing dysfunction using Modified…”

Ultrasound Screening After Cardiac Surgery Shows Vocal Fold Impairment and Predicts Aspiration

“…7,15 Several studies have demonstrated that VFMI is a risk factor for silent aspiration after congenital surgery and an independent risk factor for interstage death after the Norwood procedure, highlighting the importance of surveillance and management in this population. 1,7,16,17 Postoperative vocal fold evaluation can be critical in diagnosing asymptomatic VFI, and detecting silent aspiration earlier, as well as optimizing postoperative feeding management strategies to prevent adverse sequelae. Routine adoption of LUS as a primary modality for assessment of vocal fold motion has gained traction in the pediatric neonatal population.…”

Current opinion in otolaryngology and head and neck surgery: the role of the otolaryngologist in the management of pediatric dysphagia

“…In evaluating patients with vocal fold movement impairment, it is important to determine if this was acquired or congenital and assess the probability of return of vocal fold function and resolution of dysphagia. For instance, in the cardiac population, there are data that demonstrate that resolution of swallowing difficulties may occur independently of return of vocal fold function [52,53 ▪ ]. In addition to speech therapy, temporary or permanent interventions can be considered.…”