title: Vocal cord paralysis and Dysphagia after aortic arch reconstruction and Norwood procedure.
abstract: OBJECTIVE
  To determine the incidence of vocal cord (VC) paralysis and dysphagia after aortic arch reconstruction, including the Norwood procedure.
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Database/chart review of neonates requiring Norwood or arch surgery between January 2005 and December 2012. Demographics, postoperative VC function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long-term follow-up were reviewed.
  
  
  RESULTS
  One hundred fifty-one consecutive subjects (96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days (interquartile range [IQR], 7-13) for Norwood and 24 days (IQR, 12-49) for arch reconstruction (P < .001). Documentation of VC motion abnormality was found in 60 of 104 (57.6%) subjects and unavailable in 47 (16 without documentation and 31 who died prior to extubation). There were no significant differences in proportions of documented VC motion (P = .337), dysphagia (P = .987), and VC paralysis (P = .706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without unilateral VC paralysis (UVCP), dysphagia was present (56% Norwood, 61% arch). Overall, 120 of 151 (79.5%) required feeding evaluation and a modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55 of 151 (36.4%) patients. Of those with VC paralysis, only 23 (22%) had any otolaryngology follow-up after discharge from surgery. More than 75% with VC paralysis with follow-up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis.
  
  
  CONCLUSIONS
  There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.
authors: University of Kansas School of Medicine, Kansas City, Kansas, USA.
authors: Vinh
authors: V
authors: Pham
authors: Diana
authors: D
authors: Connelly
authors: Julie L
authors: JL
authors: Wei
authors: Kevin J
authors: KJ
authors: Sykes
authors: Jim
authors: J
authors: O'Brien
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures; D018529:Nutritional Support / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014139:Tracheostomy; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology*
keywords: Norwood; arch reconstruction; dysphagia; vocal card paralysis