Uniqueness of Laryngeal Nerve Injury Following Heart Transplantation

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

“…83 Incidence of laryngotracheal complications following heart transplantation is reported to be up to 34% 63 with rates of VFP of 2.9%. 14 Higher rates of VFP are evident amongst the lung transplant population with incidence ranging from 8-34%. 9,10,12 Interestingly, Seeliger and colleagues 10 reported that half of their cohort diagnosed with VFP were asymptomatic.…”

“…This would appear to be supported by increased rates of left sided VFP. 10,14 In addition, Taeneka and colleagues report ventricular assist device implantation to be a high risk for severe VFP which they hypothesize to be potentially related to nerve compression from enlarged cardiovascular structures or direct manipulation and retraction of the heart. 20 Given an increasing proportion of patients with end stage cardiac failure are now being supported via ventricular assist device's, the implant/explant of these devices is likely to further the risk of RLN damage.…”

“…Laryngeal framework surgery is used in the longer term or where spontaneous recovery is unlikely. 12,14,142 Early injection laryngoplasty has been adopted in some centres based on the concept that compromised glottic function places the patient at higher risk for aspiration related infection. The procedure can be conducted in-office or at the bedside and is considered low risk.…”

“…lung transplantation 12 and a high proportion of vocal fold palsy (paralysis or paresis) (VFP) with incidence ranging from 2.9 % to 34%. 9,14 OPD is well recognized as a risk factor for increased morbidity and mortality 15,16 and is estimated to cost more than US $500 million per year. 17 LD following surgery is frequently associated with incompetence in airway protection with associated risk of aspiration, poor secretion clearance and increased morbidity and mortality.…”

“…21,22 The potential etiology of voice and swallowing complications in this patient population is poorly understood and has received little attention in the literature. Cardiothoracic transplant surgery and the post-operative course are inherently complex and can involve (1) compromised respiratory function, (2) prolonged intubation, [23][24][25][26] (3) damage to the recurrent laryngeal nerve (RLN), 10,14,27 (4) intensive care unit acquired weakness, 28 (5) alterations to neurological status 9,28 and (6) chronic gastro-oesophageal reflux. [29][30][31] All these factors are known to have a direct association with swallowing and voice dysfunction.…”