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Vocal Cord Paralysis After Surgery for Acute Dissection of the Thoracic Aorta

Ioannis Hatzaras1, Jesse Bible1, Richard Shaw1, Douglas Ross2, Clarence Sasaki2, John Elefteriades1
1Yale University, section of Cardiothoracic Surgery, New Haven, CT;2Yale University, section of Head & Neck Surgery, New Haven, CT

Objective: To determine the incidence, etiology, prognosis, and treatment of vocal cord paralysis (VCP) after surgery for acute thoracic aortic dissection.
Design: Retrospective study performed between 1995 and 2004.
Setting: Academic, tertiary care, referral medical center.
Patients: We studied 175 patients (65 females, 110 males) who underwent surgery for acute non traumatic dissection of the thoracic aorta (110 ascending, 65 descending) at our institution between 1995 and 2004.
Interventions: Surgery for acute thoracic aortic dissection, Ishikki thyroplasty.
Main Outcome Measures:
Eleven patients (3 female, 8 male, mean age: 61.4 years) were diagnosed with new VCP in the immediate postoperative period following post-operative episodes of hoarseness, dysphagia, or excess coughing. Of those, 2 were operated for ascending and 9 for descending aortic dissection. Aortic pathologies included 5 intramural hematomas, 4 typical dissections, and 2 penetrating ulcers. All patients were treated with replacement of the aorta with a Hemashield tube graft. VCP incidence was higher in surgery for descending aortic dissection (9 of 65 patients, 13.8%, p= 0.0014, student’s t test). Six patients underwent the Ishikki thyroplasty procedure, with resolution of symptoms. The remaining were followed on an outpatient basis, without need for intervention.
Conclusions: Our results indicate that surgery for acute dissection of the thoracic aorta is associated with a relatively high incidence of VCP. Type II dissection shows a higher incidence, probably because of the proximity of the left recurrent laryngeal nerve to the surgical site. In those cases that did not recover spontaneously, the thyroplasty proved effective.

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