Incidence, Risk Factors, and Comorbidities of Vocal Cord Paralysis After Surgical Closure of a Patent Ductus Arteriosus: A Meta-analysis

Brandon Michael Henry,Wan Chin Hsieh,Jens Vikse,Dominik Taterra,Krzysztof A Tomaszewski,Beatrice Sanna

doi:10.1007/s00246-018-1967-8

Abstract

Surgical closure of a patent ductus arteriosus (PDA) is considered standard treatment for symptomatic neonates refractory to medical therapy. Sometimes, iatrogenic injury to the left recurrent laryngeal nerve during the procedure can result in vocal cord paralysis (VCP). This study aimed to estimate the incidence of VCP in patients after surgical PDA closure and to identify any associated risk factors and morbidities associated with VCP in the preterm infant population. A thorough search of the major electronic databases was conducted to identify studies eligible for inclusion into this meta-analysis. Studies reporting data on the incidence of VCP (primary outcomes) or risk factors and morbidities associated with VCP in premature infant population (secondary outcomes) were included. A total of 33 studies (n = 4887 patients) were included into the analysis. Overall pooled incidence estimate of VCP was 7.9% (95%CI 5.3–10.9). The incidence of VCP after PDA closure was significantly much higher in premature infants (11.2% [95%CI 7.0–16.3]) than in non-premature patients (3.0% [95%CI 1.5–4.9]). The data showed that VCP was most common after surgical ligation and in studies conducting universal laryngoscopy scoping. The risk factors for postoperative VCP in preterm infants included birth weight and gestational age. In addition, VCP was significantly associated with the occurrence of bronchopulmonary dysplasia, gastrostomy tube insertion, and increased duration of mechanical ventilation. Vocal cord paralysis remains a frequent complication of surgical closure of a PDA, especially in premature neonates, and is associated with significant post-procedural complications.

Highlights

The normal ductus arteriosus arises from the left pulmonary artery and connects to the transition area between the aortic arch and descending aorta just distal to the origin of the left subclavian artery
Comorbidities of vocal cord paralysis (VCP) Bronchopulmonary Dysplasia without VCP, indicating that preterm infants with VCP were more likely to require gastrostomy tube insertion (RR = 1.22; 95% confidence intervals (95%CI) 1.00–1.49; p = 0.03; Table 5)
The incidence of VCP after patent ductus arteriosus (PDA) closure was significantly higher in premature infants (11.2% [95%CI 7.0–16.3]) than in non-premature patients (3.0% [95%CI 1.5–4.9]), indicating premature infants are at a greater risk of VCP

Summary

Introduction

The normal ductus arteriosus arises from the left pulmonary artery and connects to the transition area between the aortic arch and descending aorta just distal to the origin of the left subclavian artery. Ductus arteriosus closes shortly after birth to facilitate proper breathing in the infant. It narrows and occludes prematurely during fetal life. It is estimated that 8 out of 1000 preterm infants will develop a patent ductus arteriosus (PDA), a condition in which the ductus arteriosus fails to close postnatally [1]. Surgical closure is considered a standard treatment for symptomatic neonates refractory to medical therapy [3, 4]. A possible adverse event of such an injury is vocal cord paralysis (VCP). Duration of vocal cord dysfunction is variable and may be transient (< 1 year) or persistent (> 1 year) [6]

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