Author(s)
Tanner M.Fullmer, MD: David C. Wang, BS
Matt Darwin Price, MS
Scott A. LeMaire, MD
Joseph S. Coselli, MD
Donald T. Donovan, MD
Julina Ongkasuwan, MD
Affiliation(s)
Baylor College of Medicine
Abstract:
Background: Vocal fold mobility impairment (VFMI) secondary to neuronal injury is a known risk factor after aortic surgery. Total arch repair is technically challenging and the incidence of recurrent laryngeal nerve injury is unknown. This study examines the incidence of VFMI after total arch replacement and inpatient medialization outcomes. Study Design: Retrospective Cohort Study Methods: All patients who underwent total arch replacement at our tertiary care center from 2006-2017 were identified through an institutional data base. A total of 358 patients were reviewed. End points included evidence of vocal fold immobility on flexible laryngoscopy, time to diagnosis, time to treatment, performance on pre-and postoperative swallow studies, ICU and hospital length of stay. Results: Nineteen percent of patients who underwent total arch replacement were diagnosed with VFMI during their initial inpatient stay. Seventy-eight percent of those injuries involved the left vocal fold, 16% were on the right and 6% were bilateral. The majority of patients (61%) received inpatient vocal fold medialization (VCM), 66% of those received injection laryngoplasty and 33% had a type 1 thyroplasty. Those with vocal fold paralysis had significantly longer stays in the intensive care unit (8.6 and 5.7 days, p=.03) and in the hospital (20.4 and 16.0 days, p=.04). Patients with VFMI, who received VCM trended toward shorter ICU (p=.08), and hospital stays (p=.5), though it was not significant. Conclusions: Incidence of VFMI following total arch replacement is similar to those receiving other aortic arch surgeries. Prospective studies and standardization is needed to evaluate treatment outcomes.