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. 2016 Jan;28(1):1-6.
doi: 10.1016/j.jsha.2015.05.002. Epub 2015 May 12.

Outcomes of recurrent laryngeal nerve injury following congenital heart surgery: A contemporary experience

Fahad A Alfares  1 , Conor F Hynes  1 , Ghedak Ansari  1 , Reginald Chounoune  1 , Manelle Ramadan  1 , Conner Shaughnessy  1 , Brian K Reilly  2 , David Zurakowski  3 , Richard A Jonas  1 , Dilip S Nath  1
Affiliations

Outcomes of recurrent laryngeal nerve injury following congenital heart surgery: A contemporary experience

Fahad A Alfares et al. J Saudi Heart Assoc. 2016 Jan.

Abstract

Objective: Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition.

Design: A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus.

Results: The incidence of post-operative vocal cord paralysis was 1.1% (32 out of 3036 patients; 95% confidence interval: 0.7-1.5%). The majority were left-sided injuries (71%). Overall rate of recovery was 61% with a median time of 10 months in those who recovered, and a total follow up of 46 months. Due to feeding complications, 45% of patients required gastrostomy tube after the injury, and these patients were found to have longer duration of post-operative days of intubation (median 10 vs. 5 days, p = 0.03), ICU length of stay (50 vs. 8 days, p = 0.002), and hospital length of stay (92 vs. 41 days, p = 0.01). No pre-operative variables were identified as predictive of recovery or need for gastrostomy placement.

Conclusion: Recurrent laryngeal nerve injury is a serious complication of congenital heart surgery that impacts post-operative morbidity, in some cases leading to a need for further intervention, in particular, gastrostomy tube placement. A prospective, multi-center study is needed to fully evaluate factors that influence severity and time to recovery.

Keywords: Congenital heart surgery; Gastrostomy tube; Recurrent laryngeal nerve injury; Vocal cord paralysis.

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Figures

Figure 1
Figure 1
Time to recovery. Kaplan–Meier analysis of time to recovery shows 65% of patients with resolution of VCP had recovered by 24 months (95% CI 50–80%).
See this image and copyright information in PMC

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