# Time Course and Predictors of Persistent Postoperative Dysphagia in Patients with Congenital Heart Disease Following Cardiac Surgery

## TL;DR

This study examines how long and why some patients with congenital heart disease continue to have difficulty swallowing after heart surgery.

## Contribution

The study identifies predictors and time course of persistent postoperative dysphagia in CHD patients.

## Key findings

- About one-third of patients remained on tube feeding due to severe dysphagia at the end of follow-up.
- VFMI recovery time was strongly correlated with dysphagia resolution time.
- Genetic syndromes and specific surgical interventions were linked to persistent tube feeding needs.

## Abstract

Describe the long-term presence, predictors, and time course of postoperative dysphagia in selected congenital heart disease (CHD) patients following cardiac surgery. Retrospective study of selected CHD patients who underwent cardiac surgery that is at high risk for dysphagia and vocal fold mobility impairment (VFMI) and underwent speech pathology assessment from 2019 to 2024. Demographics, clinical history, VFMI, dysphagia severity and feeding modality were assessed. There were 322 mostly infant patients; median age was 0.64 (IQR0.19–6.9) months. Most patients were male (177,55%) and 119 (37%) had single ventricle (SV) disease. A full PO diet was maintained in 105 (32.6%) patients throughout follow-up. One hundred and ten (34.2%) patients improved from tube feeding (TF) at initial discharge to a full PO diet in a median 10.4 months (IQR4.4–23.2), whereas 107 (33.2%) remained on TFs with severe dysphagia at the end of follow-up (median 7.2, IQR1.5–17.3 months). VFMI was present in 83 patients postoperatively. VFMI resolved in 35 (38.8%) patients in a median 4.8 months (IQR2.4–8.2). VFMI and dysphagia recovery were not associated. However, the time to VFMI recovery and time to dysphagia resolution were correlated (r = 0.77, p = 0.0001). Patients with a genetic syndrome, Blalock–Thomas-Taussig shunt and/or ventricular assist device use were more likely to require persistent TF. Patients who had coarctation/aortic arch repair or SV disease were less likely to require TF at the end of follow-up. Dysphagia necessitating tube feeding persists for several months after VFMI resolves. This study will help set prognostic expectations for caregivers.