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Ubeda Tikkanen A, Vova J, Holman L, Chrisman M, Clarkson K, Santiago R, Schonberger L, White K, Badaly D, Gauthier N, Pham TDN, Britt JJ, Crouter SE, Giangregorio M, Nathan M, Akamagwuna UO. Core components of a rehabilitation program in pediatric cardiac disease. Front Pediatr 2023; 11:1104794. [PMID: 37334215 PMCID: PMC10275574 DOI: 10.3389/fped.2023.1104794] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
There is increasing effort in both the inpatient and outpatient setting to improve care, function, and quality of life for children with congenital heart disease, and to decrease complications. As the mortality rates of surgical procedures for congenital heart disease decrease, improvement in perioperative morbidity and quality of life have become key metrics of quality of care. Quality of life and function in patients with congenital heart disease can be affected by multiple factors: the underlying heart condition, cardiac surgery, complications, and medical treatment. Some of the functional areas affected are motor abilities, exercise capacity, feeding, speech, cognition, and psychosocial adjustment. Rehabilitation interventions aim to enhance and restore functional ability and quality of life for those with physical impairments or disabilities. Interventions such as exercise training have been extensively evaluated in adults with acquired heart disease, and rehabilitation interventions for pediatric patients with congenital heart disease have similar potential to improve perioperative morbidity and quality of life. However, literature regarding the pediatric population is limited. We have gathered a multidisciplinary team of experts from major institutions to create evidence- and practice-based guidelines for pediatric cardiac rehabilitation programs in both inpatient and outpatient settings. To improve the quality of life of pediatric patients with congenital heart disease, we propose the use of individualized multidisciplinary rehabilitation programs that include: medical management; neuropsychology; nursing care; rehabilitation equipment; physical, occupational, speech, and feeding therapies; and exercise training.
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Affiliation(s)
- Ana Ubeda Tikkanen
- Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Joshua Vova
- Department of Physiatry, Children’s Healthcare of Atlanta, Atlanta, GA, United States
| | - Lainie Holman
- Department Pediatric Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States
| | - Maddie Chrisman
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Kristin Clarkson
- Department of Pediatric Physical Medicine and Rehabilitation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Rachel Santiago
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Lisa Schonberger
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Kelsey White
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Daryaneh Badaly
- Learning and Development Center, Child Mind Institute, New York, NY, United States
| | - Naomi Gauthier
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Tam Dan N. Pham
- Department of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Jolie J. Britt
- Department of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Scott E. Crouter
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee Knoxville, Knoxville, IL, United States
| | - Maeve Giangregorio
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, United States
| | - Unoma O. Akamagwuna
- Department Pediatric Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, TX, United States
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, TX, United States
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Kenny L, McIntosh A, Jardine K, Suna J, Versluis K, Slee N, Lloyd G, Justo R, Merlo G, Wilson M, Reddan T, Powell J, Venugopal P, Betts K, Alphonso N. Vocal cord dysfunction after pediatric cardiac surgery: A prospective implementation study. JTCVS OPEN 2022; 11:398-411. [PMID: 36172446 PMCID: PMC9510869 DOI: 10.1016/j.xjon.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 05/18/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
Objective To determine the incidence, outcomes, and evaluate diagnostic modalities for postoperative vocal cord dysfunction (VCD) following cardiothoracic surgery in children. Methods A prospective mixed-methods study using principles of implementation science was completed. All patients undergoing surgery involving the aortic arch, ductus, or ligamentum arteriosum and vascular rings from September 2019 to December 2020 were enrolled. Patients underwent speech pathology assessment, laryngeal ultrasound, and flexible direct laryngoscopy. Results Ninety-five patients were eligible for inclusion. The incidence of VCD ranged from 18% to 56% and varied according to procedure group. VCD occurred in 42% of neonates. Repair of hypoplastic aortic arch was associated with increased risk of VCD (57%; P = .002). There was no significant difference in duration of intubation, pediatric intensive care unit stay, or hospital stay. Forty percent children were able to achieve full oral feeding. Children with VCD were more likely to require nasogastric supplementary feeding at discharge (60% vs 36%; P = .044). Sixty-eight percent of patients demonstrated complete resolution of VCD at a median of 97 days postoperatively. Laryngeal ultrasound and speech pathology assessment combined had a sensitivity of 91% in comparison to flexible direct laryngoscopy. Conclusions VCD occurred in one-third and resolved in two-thirds of patients at a median of 3 months following cardiac surgery. Aortic arch repair carried the highest risk of VCD. VCD adversely influenced feeding. Forty percent of patients achieved full oral feeding before discharge. VCD did not delay intensive care unit or hospital discharge. Speech pathology assessment and laryngeal ultrasound combined was reliable for diagnosis in most patients and was more patient friendly than flexible direct laryngoscopy.
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Biot T, Fieux M, Henaine R, Truy E, Coudert A, Ayari-Khalfallah S. Long term outcome of laryngeal mobility disorder and quality of life after pediatric cardiac surgery. Int J Pediatr Otorhinolaryngol 2022; 158:111142. [PMID: 35580383 DOI: 10.1016/j.ijporl.2022.111142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Laryngeal mobility disorder after a pediatric heart surgery is common (between 5 and 10% of cases), and has important consequences on swallowing, breathing and speaking. After reviewing the literature, the recovery rate is variable and the postoperative follow-up is often done on a short time frame. The primary objective of the study is to describe the recovery from laryngeal mobility disorder with a follow-up time of at least 5 years. The secondary objective is to describe of the quality of life of the child in terms of phonation and swallowing, and to identify potential risk factors for a lasting laryngeal mobility disorder. METHODS We collected data (morphological characteristics and details of the procedures and medical care) on children who had undergone a heart surgery with risks of complications, between 2010 and 2015, and with a laryngeal mobility disorder detected after the surgery through nasal flexible laryngoscopy. During a follow-up consultation, carried at least 5 years after the surgery, we performed a nasal flexible laryngoscopy to assess whether or not the patient had recovered a full mobility of the larynx. Two questionnaires were also given to the patients, the pVHI and the PEDI EAT-10, to assess respectively the quality of their speech and of their swallowing function. RESULTS The recovery rate for a laryngeal mobility disorder more than 5 years after surgery was found to be 65% (9 children out of the 14 included in the study). We identified a risk factor for the persistence of a laryngeal mobility disorder after surgery: the presence of an associated genetic syndrome, p = 0.025. Children with persistent laryngeal mobility disorder have an impaired quality of life score, using the pVHI scale, which correlates well with the flexible laryngoscopy findings, p = 0.033. CONCLUSION Children with a lasting laryngeal mobility disorder have disabling respiratory and vocal symptoms in their daily lives. Nasal flexible laryngoscopy should therefore be systematically performed postoperatively after a surgery carrying risks. For improved patient management, early detection of these disorders by pharyngolaryngeal nasal flexible laryngoscopy in the aftermath of high-risk cardiac surgery is strongly advised, with prolonged follow-up.
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Affiliation(s)
- Thomas Biot
- Hospices Civils de Lyon, Hopital Edouard Herriot, Service d'ORL et de chirurgie cervico-faciale, Lyon cedex, F-69003, France
| | - Maxime Fieux
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Pierre Bénite cedex, F-69495, France; Université de Lyon, Université Lyon 1, F-69003, Lyon, France; Université Paris Est Creteil, INSERM, IMRB, F-94010, Créteil, France; CNRS ERL 7000, F-94010, Créteil, France.
| | - Roland Henaine
- Université de Lyon, Université Lyon 1, F-69003, Lyon, France; Department of Adult and Child Cardiovascular Surgery and Heart Transplantation, Louis Pradel Cardiologic Hospital, Bron, France
| | - Eric Truy
- Hospices Civils de Lyon, Hopital Edouard Herriot, Service d'ORL et de chirurgie cervico-faciale, Lyon cedex, F-69003, France; Université de Lyon, Université Lyon 1, F-69003, Lyon, France; Inserm U1028, Lyon Neuroscience Research Center, Equipe IMPACT, Lyon, France; Hospices Civils de Lyon, Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Bron Cedex, F-69500, France
| | - Aurelie Coudert
- Hospices Civils de Lyon, Hopital Edouard Herriot, Service d'ORL et de chirurgie cervico-faciale, Lyon cedex, F-69003, France; Hospices Civils de Lyon, Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Bron Cedex, F-69500, France
| | - Sonia Ayari-Khalfallah
- Hospices Civils de Lyon, Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Bron Cedex, F-69500, France
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Oral feeding dysfunction in post-operative infants with CHDs: a scoping review. Cardiol Young 2022; 33:570-578. [PMID: 35450551 PMCID: PMC9652479 DOI: 10.1017/s1047951122001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Post-operative oral feeding difficulties in neonates and infants with CHD is common. While pre-operative oral feeding may be normal, oral feeding challenges manifest in the post-operative period without a clearly defined aetiology. The objective of this scoping review was to examine post-operative oral feeding in full-term neonates and infants with a CHD. Electronic databases query (1 January 1975-31 May 2021), hand-search of the reference lists of included studies, contact with experts, and review of relevant conferences were performed to identify quantitative studies evaluating post-operative oral feeding in full-term neonates and infants with a CHD. Associations with additional quantitative variables in these studies were also examined. Twenty-five studies met inclusion criteria. Eighty per cent were cohort studies that utilised retrospective chart review from a single institution. The primary variable of interest in all studies was oral feeding status upon discharge from neonatal hospitalisation. The most common risk factors evaluated with poor feeding at time of discharge were birth weight (36% of included studies), gestational age (44%), duration of post-operative intubation (48%), cardiac diagnosis (40%), and presence of genetic syndrome or chromosomal anomaly (36%). The most common health-related outcomes evaluated were length of hospital stay (40%) and length of ICU stay (16%). Only the health-related outcomes of length of hospital stay and length of ICU stay were consistently significantly associated with poor post-operative oral feeding across studies in this review. A clear aetiology of poor post-operative oral feeding remains unknown.
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Pettigrew J, Tzannes G, Swift L, Docking K, Osland K, Cheng AT. Surgically Acquired Vocal Cord Palsy in Infants and Children with Congenital Heart Disease (CHD): Description of Feeding Outcomes. Dysphagia 2022; 37:1288-1304. [PMID: 34981253 DOI: 10.1007/s00455-021-10390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Abstract
Impaired swallowing in infants can impact upon the ability to feed orally, often resulting in dependency on supplementary feeding. Such difficulties can lead to an increased burden of care and associated costs. The primary aim of this study was to investigate the impact of vocal cord palsy (VCP), acquired intraoperatively during cardiac surgery, on the feeding outcomes of infants at a tertiary metropolitan children's hospital. An additional aim was to obtain preliminary information on the impact of feeding difficulties in this group on the quality of life of parents and families. A review of 48 patients who had been referred to the speech pathology service was undertaken. Participants presented with heterogeneous cardiac diagnoses, and had an initial Videofluoroscopic Swallow Study (VFSS) at a median corrected age of 3.6 weeks. Sixty percent of participants presented with silent aspiration on VFSS. Thirty percent of participants required supplementary tube feeding more than 6 months post-surgery. Six percent of participants with poor feeding progress and persistent aspiration required further surgical intervention to support nutrition. Findings revealed no significant relationship between participant factors and the presence of feeding difficulties, however, infants with concomitant genetic and syndromic conditions were found to be most at-risk for long-term feeding difficulties. Analysis of informal parent questionnaire responses indicated parents experienced stress and anxiety after their child's discharge. This was noted in regard to their child's feeding, which impacts quality of life across a number of domains. Findings of this study highlight the importance of communicating the potential feeding difficulties to parents of at-risk infants prior to cardiac surgery. This study further highlighted the importance of routine post-operative otorhinolaryngology examinations following high-risk surgeries, as well as speech pathology management for all infants and children identified with VCP. Post-operative input from appropriately trained Speech Pathologists is vital in assisting parents to support and mitigate their child's difficulties through the provision of early intervention for feeding difficulties.
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Affiliation(s)
- Jane Pettigrew
- Speech Pathology Department, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia.
| | - Gloria Tzannes
- Speech Pathology Department, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia
| | - Laura Swift
- Speech Pathology Department, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia
| | - Kimberley Docking
- NeuroKids Communication Research Laboratory, Faculty Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Kate Osland
- Speech Pathology Department, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia
| | - Alan T Cheng
- ENT Department, The Children's Hospital at Westmead, The Sydney Children's Hospital Network, Westmead Campus, Cnr Hawkesbury Road and Hainsworth St, Westmead, NSW, 2145, Australia
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Barr JM, Bowman K, Deshpande M, Dewey EN, Milczuk HA, Vo J, Shen I, Muralidaran A. Incidence and Recovery of Vocal Fold Immobility Following Pediatric Cardiac Operations. World J Pediatr Congenit Heart Surg 2021; 12:535-541. [PMID: 34278856 DOI: 10.1177/21501351211015922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Loss of laryngeal function after congenital cardiac surgery causes morbidity and prolongs hospitalization. Early diagnosis of vocal fold immobility (VFI) and referral to pediatric otolaryngology (pOTO) aids in laryngeal rehabilitation. Understanding the incidence and recovery rates of VFI enables counseling for families of infants undergoing high-risk surgery. METHODS A retrospective chart review from November 2014 to July 2019 of infants postcardiac surgery where the aortic arch or surrounding structures were manipulated and were screened via flexible fiberoptic laryngoscopy (FFL) at a single institution was performed. Patients were divided into five surgical categories: Norwood procedure, aortic arch augmentation via median sternotomy, arterial switch operation, coarctation repair via lateral thoracotomy, and cardiac surgeries including ligation of a patent ductus arteriosus (PDA). Patients undergoing isolated PDA ligation were excluded. RESULTS One hundred ninety-nine qualifying operations occurred during this period; 28 patients did not undergo FFL before discharge and were excluded from the analysis. Immediately following cardiac surgery, 34% (58 of 171 patients) had VFI. Follow-up was completed by 38 of 58 patients with VFI. Complete recovery was demonstrated in 63% (24 of 38) of patients by 6 months and in 86% (33 of 38) within 18 months. The highest risk occurred with the Norwood procedure and arch augmentation via median sternotomy. CONCLUSIONS Infants undergoing surgery involving the aortic arch and surrounding structures have high rates of VFI. Follow-up by pOTO is recommended to optimize laryngeal rehabilitation. Most patients have spontaneous recovery within 18 months of cardiac surgery.
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Affiliation(s)
- Jennifer M Barr
- Section of Pediatric and Congenital Cardiac Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Kandice Bowman
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Monica Deshpande
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth N Dewey
- Department of Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Henry A Milczuk
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Johnson Vo
- Division of Gastroenterology, Department of Medicine, 6684Oregon Health & Science University, Portland, OR, USA
| | - Irving Shen
- Section of Pediatric and Congenital Cardiac Surgery, 6684Oregon Health & Science University, Portland, OR, USA
| | - Ashok Muralidaran
- Section of Pediatric and Congenital Cardiac Surgery, 6684Oregon Health & Science University, Portland, OR, USA
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Ubeda Tikkanen A, Berry E, LeCount E, Engstler K, Sager M, Esteso P. Rehabilitation in Pediatric Heart Failure and Heart Transplant. Front Pediatr 2021; 9:674156. [PMID: 34095033 PMCID: PMC8170027 DOI: 10.3389/fped.2021.674156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
Survival of pediatric patients with heart failure has improved due to medical and surgical advances over the past decades. The complexity of pediatric heart transplant patients has increased as medical and surgical management for patients with congenital heart disease continues to improve. Quality of life in patients with heart failure and transplant might be affected by the impact on functional status that heart failure, heart failure complications or treatment might have. Functional areas affected might be motor, exercise capacity, feeding, speech and/or cognition. The goal of rehabilitation is to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. Some of these rehabilitation interventions such as exercise training have been extensively evaluated in adults with heart failure. Literature in the pediatric population is limited yet promising. The use of additional rehabilitation interventions geared toward specific complications experienced by patients with heart failure or heart transplant are potentially helpful. The use of individualized multidisciplinary rehabilitation program that includes medical management, rehabilitation equipment and the use of physical, occupational, speech and feeding therapies can help improve the quality of life of patients with heart failure and transplant.
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Affiliation(s)
- Ana Ubeda Tikkanen
- Department of Pediatric Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Emily Berry
- Department of Physical Therapy and Occupational Therapy Services, Boston Children’s Hospital, Boston, MA, United States
| | - Erin LeCount
- Department of Physical Therapy and Occupational Therapy Services, Boston Children’s Hospital, Boston, MA, United States
| | - Katherine Engstler
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
| | - Meredith Sager
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, United States
- Augmentative Communication Program, Boston Children’s Hospital, Boston, MA, United States
| | - Paul Esteso
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Devlin PJ, McCrindle BW, Kirklin JK, Blackstone EH, DeCampli WM, Caldarone CA, Dodge-Khatami A, Eghtesady P, Meza JM, Gruber PJ, Guleserian KJ, Alsoufi B, Lambert LM, O'Brien JE, Austin EH, Jacobs JP, Karamlou T. Intervention for arch obstruction after the Norwood procedure: Prevalence, associated factors, and practice variability. J Thorac Cardiovasc Surg 2018; 157:684-695.e8. [PMID: 30669228 DOI: 10.1016/j.jtcvs.2018.09.130] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/28/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Arch obstruction after the Norwood procedure is common and contributes to mortality. We determined the prevalence, associated factors, and practice variability of arch reintervention and assessed whether arch reintervention is associated with mortality. METHODS From 2005 to 2017, 593 neonates in the Congenital Heart Surgeons' Society Critical Left Heart Obstruction cohort underwent a Norwood procedure. Median follow-up was 3.7 years. Multivariable parametric models, including a modulated renewal analysis, were performed. RESULTS Of the 593 neonates, 146 (25%) underwent 218 reinterventions for arch obstruction after the Norwood procedure: catheter-based (n = 168) or surgical (n = 50) at a median age of 4.3 months (quartile 1-quartile 3, 2.6-5.7). Interdigitation of the distal aortic anastomosis was protective against arch reintervention. Development of ≥ moderate tricuspid valve regurgitation and right ventricular dysfunction at any point was associated with arch reintervention. Nonsignificant variables for arch reintervention included shunt type and preoperative aortic measurements. Surgical arch reintervention was protective against arch reintervention, but transcatheter reintervention was associated with increased reintervention. Arch reintervention was not associated with increased mortality. There was wide institutional variation in incidence of arch reintervention (range, 0-40 reinterventions per 100 years patient follow-up) and in preintervention gradient (range, 0-64 mm Hg). CONCLUSIONS Interdigitation of the distal aortic anastomosis during the Norwood procedure decreased the risk of arch reintervention. Surgical arch reintervention is more definitive than transcatheter. Arch reintervention after the Norwood procedure is not associated with increased mortality. Serial surveillance for arch obstruction, integrated with changes in right ventricular function and tricuspid valve regurgitation, is recommended after the Norwood procedure to improve outcomes.
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Affiliation(s)
- Paul J Devlin
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Brian W McCrindle
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Eugene H Blackstone
- Division of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | | | - Ali Dodge-Khatami
- Division of Pediatric Cardiac Surgery, The University of Mississippi Medical Center, Jackson, Miss
| | - Pirooz Eghtesady
- Department of Pediatric Cardiothoracic Surgery, Washington University Medical School, St Louis, Mo
| | - James M Meza
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Peter J Gruber
- Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | | | - Bahaaladin Alsoufi
- Cardiovascular Surgery, Norton Children's Hospital, University of Louisville, Louisville, Ky
| | - Linda M Lambert
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah
| | - James E O'Brien
- The Ward Family Heart Center, Children's Mercy Hospitals and Clinics, Kansas City, Mo
| | - Erle H Austin
- Cardiovascular Surgery, Norton Children's Hospital, University of Louisville, Louisville, Ky
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Rady Children's Hospital, San Diego, Calif
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Lee MG, Millar J, Rose E, Jones A, Wood D, Luitingh TL, Zannino D, Brink J, Konstantinov IE, Brizard CP, d'Udekem Y. Laryngeal ultrasound detects a high incidence of vocal cord paresis after aortic arch repair in neonates and young children. J Thorac Cardiovasc Surg 2018; 155:2579-2587. [DOI: 10.1016/j.jtcvs.2017.12.133] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/09/2017] [Accepted: 12/24/2017] [Indexed: 01/19/2023]
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10
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Stewart AJ, Butler CR, Muthialu N, Sell D, Marchant J, Hewitt RJD, Elliott MJ. Swallowing outcomes in children after slide tracheoplasty. Int J Pediatr Otorhinolaryngol 2018; 108:85-90. [PMID: 29605373 DOI: 10.1016/j.ijporl.2018.02.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Slide tracheoplasty is now considered gold standard treatment for long segment congenital tracheal stenosis. Outcomes are typically focused upon airway patency. Dysphagia is often reported in children undergoing cardiothoracic surgery, but not specifically after slide tracheoplasty. This study was carried out to describe the nature and prevalence of dysphagia following slide tracheoplasty for long segment congenital tracheal stenosis. METHODS Retrospective case note review was conducted on a series of patients who underwent swallow evaluation following slide tracheoplasty between 2006 and 2014. A clinical swallow assessment was carried out by a Speech and Language Therapist with videofluoroscopic evaluation of swallowing where indicated. Logistic regression assessed the impact of gender, feeding history, weight, tracheal diameter, stenting and co-morbidities on the likelihood of having post-operative dysphagia. RESULTS 43 out of 83 slide tracheoplasty patients underwent swallow evaluation. Dysphagia was identified in 30 (70%) of 43 patients. Videofluoroscopy was undertaken in 22 of these patients. All patients who had a videofluoroscopy presented with altered swallow physiology. Aspiration risk was confirmed in 15 patients with frank aspiration seen in 9. Pre-operative history of dysphagia was present in 9 patients. There were two cases of vocal fold palsy. The presence of a stent was the strongest predictor of post-operative dysphagia with an odds ratio of 10.6 (95% CI 1.2-92.8). CONCLUSIONS This study documents a high prevalence of post-operative dysphagia in a pediatric population following slide tracheoplasty. In most cases there was no history suggestive of dysphagia pre-operatively. Swallowing needs to be assessed after slide tracheoplasty and longitudinal studies are required.
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Affiliation(s)
- Alexandra J Stewart
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
| | - Colin R Butler
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Nagarajan Muthialu
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Debbie Sell
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Joseph Marchant
- Department of Speech and Language Therapy, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Richard J D Hewitt
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Martin J Elliott
- The National Service for Severe Tracheal Disease in Children, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
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Affiliation(s)
- Scott M Bradley
- Section of Pediatric Cardiac Surgery, Medical University of South Carolina, Charleston, SC.
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Davies RR. Invited Commentary. Ann Thorac Surg 2017; 104:1618-1619. [PMID: 29054212 DOI: 10.1016/j.athoracsur.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/05/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ryan R Davies
- Nemours Cardiac Center, A.I. duPont Hospital for Children, Wilmington, Delaware; Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, 1600 Rockland Rd, Wilmington, DE 19803.
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Sughimoto K, Pratap H, Konstantinov IE, Brizard CP, d’Udekem Y. Skeletonization of the Recurrent Laryngeal Nerve During Norwood Procedure and Aortic Arch Repair. Ann Thorac Surg 2015; 100:1473-5. [DOI: 10.1016/j.athoracsur.2015.04.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/13/2015] [Accepted: 04/17/2015] [Indexed: 11/25/2022]
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