# Prevalence, Clinical Factors and Impact of Dysphagia After Cardiac Surgery for Congenital Heart Disease

## TL;DR

This study examines how common and impactful swallowing difficulties are after heart surgery for congenital heart disease in infants and identifies factors that predict the need for tube feeding.

## Contribution

The study introduces a protocolized approach to manage dysphagia based on predictable clinical factors after cardiac surgery for CHD.

## Key findings

- Perioperative dysphagia requiring tube feeding is common after cardiac surgery for CHD.
- Single ventricle disease, vocal cord motion impairment, and clinical concern for aspiration are significant predictors of tube feeding at discharge.
- A longer time between surgery and evaluation is strongly associated with the need for tube feeding.

## Abstract

Investigate the prevalence, instigating factors, and clinical impact of dysphagia in the perioperative period after cardiac surgery for congenital heart disease (CHD) to develop a management protocol. We evaluated patients that underwent selected cardiac surgeries for CHD that had a feeding evaluation over a 5-years period from 2018 to 2023 at a university based, tertiary care urban pediatric hospital. Demographic information, medical and surgical history, vocal fold mobility, clinical and instrumental swallow evaluation findings and feeding modality were reviewed. There were 398 (predominately infant) patients, median age at surgery was 1.1 (IQR 0.20–9.9) months with 181 (46%) females. A clinical and/or instrumental feeding evaluation was performed in all patients. Tube feeding was the primary means of feeding in 232 (58.3%) of patients at the time of initial postoperative discharge. Postoperative instrumental swallow data was available in 198 (49.7%) of patients. The median dysphagia outcomes and severity score (DOSS) of these patients was 4 (IQR2-5). Multivariable analysis demonstrated that single ventricle cardiac disease (OR 5.1, p = 0.018), vocal cord motion impairment (VFMI) (OR 5.6, p = 0.002), clinical concern for aspiration on postoperative evaluation (OR 6.1, p = 0.005), and a longer time between surgery and post-surgery clinical evaluation (OR 26.7, p = 0.048) were associated with need for tube feeding at discharge. Perioperative dysphagia requiring tube feeding is common after cardiac surgery for patients with CHD. The incidence is influenced by predicable factors. A protocolized approach utilizing these factors to screen for and manage perioperative dysphagia in these patients can improve their care.