P277. Recurrent Laryngeal Nerve Injury in Aortic Arch Replacement
University of Colorado Anschutz Medical Center
Aurora, CO
United States - Contact Me
Elizabeth "Beth" Devine, PA-C
Beth is a Senior Instructor in the Division of Cardiothoracic Surgery at University of Colorado Anschutz Medical Campus. She holds the position of Coordinator for the Comprehensive Thoracic Aortic Program. Within this role she directly cares for aortic patients through their spectrum of care which may include surveillance, surgical evaluation or post operative care. She has created several pathways and protocol development to aid in care of complex aortic patients. She also collaborates with other providers and specialties to create a multidisciplinary approach to complex patient care. She primarily works with the Comprehensive Thoracic Aortic Program Director, T. Brett Reece, MD, and Muhammad Aftab, MD.
Beth received her Masters of Science in Physician Assistant Studies from Western University of Health Sciences in 2006. For the next 10 years she worked in critical care medicine in St. Louis, MO. In 2016, she relocated to Denver and began working in the CT ICU at University Hospital. In 2019, she became the Coordinator of the Thoracic Aortic Program.
Description
Elizabeth Devine, PA-C, Matthew Clary, MD, Jessica AY Rove, MD, Muhammad Aftab, MD, T. Brett Reece, MD.
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado, Aurora, CO.
Objective: Vocal cord dysfunction secondary to recurrent laryngeal nerve (RLN) injury following aortic arch surgery can cause significant morbidity and mortality. However, the incidence is unknown because aspiration is likely underrecognized. This study aims to identify the true incidence of RLN injury prior to and after operation to reduce the patient burden of silent aspiration and sequelae of complications through early identification and aggressive treatment.
Methods: Protocol was instituted in 2019 to include all elective and emergent patients getting aortic arch replacement (zone 1, zone 2 or FET). During this time, we evaluated 87 patients. On elective basis, pre and post operative direct laryngoscopy was requested to document bilateral vocal cord function. Emergent cases received post operative direct laryngoscopy only. Per Otolaryngology recommendations, patients could progress post operative diet and swallowing prior to direct laryngoscopy if asymptomatic per bedside nurse exam or speech language therapist evaluation.
Results: Due to COVID, coordination of full pre and post operative evaluations was limited. 63 patients had normal functioning vocal cords post operative. 12 patients had abnormal vocal cord function post operative but 6 of those did not have preoperative exam completed due to the emergent nature of their presentation. 4 patients had abnormal functioning vocal cord pre and post operative. 8 patients had normal preoperative exam but no post operative exam due to refusal or death.
Conclusions: RLN injury resulting in vocal cord dysfunction can be a source of morbidity and mortality. This data suggests both pre and postoperative vocal cord evaluations can be helpful and is relevant to surgical plan, clinical course and post operative recovery. The operative approach can be altered if unilateral vocal cord dysfunction is present preoperatively to avoid potential bilateral vocal cord dysfunction. Early recognition and treatment of vocal cord dysfunction post operative decreases mortality and morbidity. Understanding the injury can help to optimize patient's outcomes.
Authors
Elizabeth Devine (1), Matthew Clary (1), Jessica Rove (2), Muhammad Aftab (3), T. Brett Reece (4)
Institutions
(1) University of Colorado, Anschutz Medical Campus, Aurora, CO, (2) University of Colorado Anschutz Medical Center and Rocky Mountain Regional VAMC, Aurora, CO, (3) University of Colorado, Anschutz Medical Center, Aurora, Colorado, Aurora, CO, (4) University of Colorado Hospital, Aurora, CO