Hashim Liza, Chaves Alicia, Conaway Mark, Vergales Jeffrey
Division of Cardiology, Department of Pediatrics, University of Virginia Health Systems, Charlottesville, VA, USA.
Pediatric Cardiology, UVA Medical Center, 1215 Lee Street, Charlottesville, VA, 22903, USA.
Pediatr Cardiol. 2025 Jun 15. doi: 10.1007/s00246-025-03919-0.
The Norwood operation is associated with postoperative complications including vocal cord dysfunction (VCD). This multicenter study evaluates VCD prevalence, risk factors, and diagnostic practices in a high-risk population. We performed a retrospective review of data from the National Pediatric Cardiology Quality Improvement Collaborative registry, examining infants who underwent the Norwood operation (S1P) with a surgical shunt and either completed stage 2 palliation or died after S1P discharge. The primary outcome was the endoscopic diagnosis of VCD after Norwood operation. Analysis of patient characteristics, operative details, and postoperative outcomes was performed to identify associations with VCD. Center variation in VCD was also assessed. Among the 2342 infants, VCD was diagnosed in 21.7%. Aortic arch reintervention (AAR) occurred in 19% and was associated with higher odds of VCD (OR 1.525, p = 0.001). Infants with VCD had higher rates of G-tube placement (42% vs. 22%, p < 0.001), though tracheostomy was uncommon (3.3%). Center analysis revealed lower rates of VCD at higher volume centers. Over time, AAR rates declined while VCD diagnoses increased. Our findings suggest that the Norwood operation plays a significant role in the development of VCD. The link between AAR and VCD is complex but may be influenced by institutional differences in evaluation practices. Given its impact on feeding and potential for persistence, VCD represents an important postoperative complication. Comprehensive postoperative care, low threshold to screen for VCD, and a multidisciplinary approach to management is needed to continually improve outcomes in infants undergoing the Norwood operation.
诺伍德手术与包括声带功能障碍（VCD）在内的术后并发症相关。这项多中心研究评估了高危人群中VCD的患病率、危险因素和诊断方法。我们对国家儿科心脏病学质量改进协作登记处的数据进行了回顾性分析，研究对象为接受诺伍德手术（S1P）并进行外科分流的婴儿，这些婴儿要么完成了二期姑息治疗，要么在S1P出院后死亡。主要结局是诺伍德手术后VCD的内镜诊断。对患者特征、手术细节和术后结局进行分析，以确定与VCD的关联。还评估了各中心在VCD方面的差异。在2342名婴儿中，21.7%被诊断为VCD。19%的婴儿进行了主动脉弓再次干预（AAR），且AAR与VCD的较高发生率相关（OR 1.525，p = 0.001）。患有VCD的婴儿胃造瘘管置入率较高（42%对22%，p < 0.001），不过气管切开术并不常见（3.3%）。中心分析显示，手术量较大的中心VCD发生率较低。随着时间的推移，AAR发生率下降，而VCD诊断率上升。我们的研究结果表明，诺伍德手术在VCD的发生中起重要作用。AAR与VCD之间的联系很复杂，但可能受评估方法的机构差异影响。鉴于其对喂养的影响和持续存在的可能性，VCD是一种重要的术后并发症。需要全面的术后护理、对VCD进行筛查的低门槛以及多学科管理方法，以持续改善接受诺伍德手术婴儿的结局。
