# Evaluating Vocal Cord Dysfunction in Infants Following the Norwood Operation: A National Pediatric Cardiology Quality Improvement Collaborative Analysis

## TL;DR

This study finds that vocal cord dysfunction is a common complication in infants after a Norwood operation, with aortic arch reintervention linked to higher risk.

## Contribution

The study provides new insights into the prevalence and risk factors for vocal cord dysfunction in infants undergoing the Norwood operation.

## Key findings

- Vocal cord dysfunction was diagnosed in 21.7% of infants after the Norwood operation.
- Aortic arch reintervention was associated with higher odds of vocal cord dysfunction (OR 1.525).
- Higher volume centers had lower rates of vocal cord dysfunction diagnoses.

## Abstract

The Norwood operation is associated with postoperative complications including vocal cord dysfunction (VCD). This multicenter study evaluates VCD prevalence, risk factors, and diagnostic practices in a high-risk population. We performed a retrospective review of data from the National Pediatric Cardiology Quality Improvement Collaborative registry, examining infants who underwent the Norwood operation (S1P) with a surgical shunt and either completed stage 2 palliation or died after S1P discharge. The primary outcome was the endoscopic diagnosis of VCD after Norwood operation. Analysis of patient characteristics, operative details, and postoperative outcomes was performed to identify associations with VCD. Center variation in VCD was also assessed. Among the 2342 infants, VCD was diagnosed in 21.7%. Aortic arch reintervention (AAR) occurred in 19% and was associated with higher odds of VCD (OR 1.525, p = 0.001). Infants with VCD had higher rates of G-tube placement (42% vs. 22%, p < 0.001), though tracheostomy was uncommon (3.3%). Center analysis revealed lower rates of VCD at higher volume centers. Over time, AAR rates declined while VCD diagnoses increased. Our findings suggest that the Norwood operation plays a significant role in the development of VCD. The link between AAR and VCD is complex but may be influenced by institutional differences in evaluation practices. Given its impact on feeding and potential for persistence, VCD represents an important postoperative complication. Comprehensive postoperative care, low threshold to screen for VCD, and a multidisciplinary approach to management is needed to continually improve outcomes in infants undergoing the Norwood operation.