Vocal Cord Paralysis and Laryngeal Trauma in Cardiac Surgery

Background: Cardiac surgery associated iatrogenic laryngeal trauma is often overlooked. We investigated the risk factors of vocal cord paralysis in cardiac surgery. Methods: Medical records were reviewed from 169 patients who underwent elective or emergency cardiac surgeries. Patients had transesophageal echocardiography (TEE) placed either under video fiberscopic image guidance (guided group) or blind placement (blind group). Routine postoperative otolaryngologist consultation with video laryngoscopic recording were performed. Results: Vocal cord paralyses were found in 18 patients (10.7%; left-13, right-4, bilateral-1). The risk of vocal cord paralysis was associated with emergency operation [odds ratio, 97.5 (95% confidence interval [CI], 2.9 to 366), p = 0.01]. Use of fiberscope-guided TEE [odds ratio, 0.04 (95% CI 0.01 to 0.87), p = 0.04] can effectively reduce vocal cord injury. Conclusions: Emergency cardiac surgery increased the risk of vocal cord paralysis. Fiberscope-guided TEE placement is recommended for all patients having cardiac surgery to decrease the risk of severe peri-operative laryngeal trauma.