Pourmoghadam Kamal K, DeCampli William M, Ruzmetov Mark, Kosko James, Kishawi Sami, O'Brien Michael, Cowden Amanda, Piggott Kurt, Fakioglu Harun
Section of Pediatric Cardiovascular Surgery, Arnold Palmer Hospital for Children, Orlando, Florida; Department of Surgery, Arnold Palmer Hospital for Children and University of Central Florida College of Medicine, Orlando, Florida.
Section of Pediatric Cardiovascular Surgery, Arnold Palmer Hospital for Children, Orlando, Florida; Department of Surgery, Arnold Palmer Hospital for Children and University of Central Florida College of Medicine, Orlando, Florida.
Ann Thorac Surg. 2017 Nov;104(5):1611-1618. doi: 10.1016/j.athoracsur.2017.03.080. Epub 2017 Jun 23.
We evaluated the incidence, clinical effect, and recovery rate of vocal cord dysfunction (VCD) and swallowing dysfunction in neonates undergoing aortic arch repair.
We retrospectively evaluated 101 neonates who underwent aortic arch reconstruction from 2008 to 2015. Direct flexible laryngoscopy was performed in 89 patients before initiation of postoperative oral feeding after Norwood (n = 63) and non-Norwood (n = 26) arch reconstruction. We defined VCD as immobility of vocal cords or their lack of coaptation and poor mobility.
The incidence of VCD after aortic arch repair was 48% (n = 43). There was no significant difference between the VCD and non-VCD groups in postoperative length of stay, extubation failure, cardiopulmonary bypass, cross-clamp, selective cerebral perfusion time, operative death, and The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Congenital Heart Surgery Mortality Categories. Placement of gastrostomy (p = 0.03) and documented aspiration (p = 0.01) were significantly more common in VCD patients. The incidence of VCD was 41% (n = 26) after Norwood and 65% (n = 17) after non-Norwood repairs (p = 0.06). Gastrostomy was required in 44 Norwood patients vs 9 non-Norwood patients (p = 0.004). Median length of stay was similar in Norwood patients with or without VCD (p = .28) but was significantly longer in non-Norwood patients with VCD vs those without (p = 0.002). At follow-up direct flexible laryngoscopy, VCD recovery was 74% (14 of 19) in the Norwood group and 86% (12 of 14) in the non-Norwood group.
The incidence of VCD and swallowing dysfunction in neonates undergoing aortic arch reconstruction is high. Patients with VCD have a significantly higher incidence of gastrostomy placement and aspiration. In the Norwood population, length of stay is not associated with presence or absence of VCD. More than 70% of patients in each group who had direct flexible laryngoscopy follow-up recovered vocal cord function.
我们评估了接受主动脉弓修复术的新生儿声带功能障碍（VCD）和吞咽功能障碍的发生率、临床效果及恢复率。
我们回顾性评估了2008年至2015年间接受主动脉弓重建术的101例新生儿。89例患者在诺伍德（n = 63）和非诺伍德（n = 26）弓重建术后开始经口喂养前接受了直接软性喉镜检查。我们将VCD定义为声带不动或不能贴合以及活动不良。
主动脉弓修复术后VCD的发生率为48%（n = 43）。VCD组和非VCD组在术后住院时间、拔管失败、体外循环、主动脉阻断、选择性脑灌注时间、手术死亡以及胸外科医师协会-欧洲心胸外科协会（STAT）先天性心脏病手术死亡率分类方面无显著差异。胃造口术的施行（p = 0.03）和记录到的误吸（p = 0.01）在VCD患者中明显更常见。诺伍德术后VCD的发生率为41%（n = 26），非诺伍德修复术后为65%（n = 17）（p = 0.06）。44例诺伍德患者与9例非诺伍德患者需要进行胃造口术（p = 0.004）。诺伍德有或无VCD患者的住院时间中位数相似（p = 0.28），但非诺伍德有VCD患者的住院时间明显长于无VCD患者（p = 0.002）。在随访直接软性喉镜检查时，诺伍德组VCD恢复率为74%（19例中的14例），非诺伍德组为86%（14例中的12例）。
接受主动脉弓重建术的新生儿VCD和吞咽功能障碍的发生率很高。VCD患者胃造口术施行率和误吸发生率明显更高。在诺伍德人群中，住院时间与VCD的有无无关。每组接受直接软性喉镜检查随访的患者中，超过70%的患者声带功能恢复。
