Sharaf Omar M, Hao Kevin A, Demos Daniel S, Plowman Emily K, Ahmed Mustafa M, Jeng Eric I
Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA.
Division of Cardiovascular Medicine, University of Florida Health, Gainesville, USA.
Cureus. 2023 Jul 22;15(7):e42291. doi: 10.7759/cureus.42291. eCollection 2023 Jul.
Objective Dysphagia following cardiac surgery is common and associated with adverse outcomes. Among patients receiving left ventricular assist devices (LVAD), we evaluated the impact of fiberoptic endoscopic evaluation of swallowing (FEES) on outcomes. Methods A single-center pilot study was conducted in adults (≥18 years of age) undergoing durable LVAD (February 2019 - January 2020). Six patients were prospectively enrolled, evaluated, and underwent FEES within 72 hours of extubation-they were compared to 12 control patients. Demographic, surgical, and postoperative outcomes were collected. Unpaired two-sided t-tests and Fisher's exact tests were performed. Results Baseline characteristics were similar between groups. Intraoperative criteria including duration of transesophageal echo (314 ± 86 min) and surgery (301 ± 74 min) did not differ. The mean time of intubation was comparable (57.3 vs. 68.7 hours, =0.77). In the entire cohort, 30-day, one-year, two-year, and three-year mortality were 0%, 5.6%, 5.6%, and 16.7%, respectively. Sixty-seven percent of the patients that underwent FEES had inefficient swallowing function. The FEES group trended to a shorter hospital length of stay (LOS) (29.1 vs. 46.6 days, =0.098), post-implantation LOS (25.3 vs 30.7 days, =0.46), and lower incidence of postoperative pneumonia (16.7% vs. 50%, =0.32) and sepsis (0% vs. 33.3%, =0.25). Conclusion FEES did not impact 30-day, one-year, two-year, or three-year mortality. Though not statistically significant, patients who underwent FEES trended toward shorter LOS and lower postoperative pneumonia and sepsis rates. Additionally, we report a higher incidence of dysphagia among patients undergoing FEES despite comparable baseline risk factors with controls.
目的 心脏手术后吞咽困难很常见且与不良后果相关。在接受左心室辅助装置(LVAD)的患者中,我们评估了纤维内镜吞咽功能评估(FEES)对预后的影响。方法 对2019年2月至2020年1月期间接受持久LVAD的成人(≥18岁)进行单中心前瞻性研究。前瞻性纳入6例患者,在拔管后72小时内进行评估并接受FEES,将他们与12例对照患者进行比较。收集人口统计学、手术和术后结果。进行非配对双侧t检验和Fisher精确检验。结果 两组间基线特征相似。包括经食管超声心动图持续时间(314±86分钟)和手术时间(301±74分钟)在内的术中标准无差异。平均插管时间相当(57.3对68.7小时,P=0.77)。在整个队列中,30天、1年、2年和3年死亡率分别为0%、5.6%、5.6%和16.7%。接受FEES的患者中有67%吞咽功能低效。FEES组住院时间(LOS)有缩短趋势(29.1对46.6天,P=0.098),植入后LOS(25.3对30.7天,P=0.46),术后肺炎发生率较低(16.7%对50%,P=0.32),败血症发生率较低(0%对33.3%,P=0.25)。结论 FEES对30天、1年、2年或3年死亡率无影响。尽管无统计学意义,但接受FEES的患者住院时间有缩短趋势,术后肺炎和败血症发生率较低。此外,尽管与对照组基线风险因素相当,但我们报告接受FEES的患者吞咽困难发生率较高。