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Meta-Analysis
. 2019 Jan;40(1):116-125.
doi: 10.1007/s00246-018-1967-8. Epub 2018 Aug 24.

Incidence, Risk Factors, and Comorbidities of Vocal Cord Paralysis After Surgical Closure of a Patent Ductus Arteriosus: A Meta-analysis

Brandon Michael Henry  1   2 , Wan Chin Hsieh  3   4 , Beatrice Sanna  3 , Jens Vikse  3   5 , Dominik Taterra  3   6 , Krzysztof A Tomaszewski  3   6
Affiliations
Meta-Analysis

Incidence, Risk Factors, and Comorbidities of Vocal Cord Paralysis After Surgical Closure of a Patent Ductus Arteriosus: A Meta-analysis

Brandon Michael Henry et al. Pediatr Cardiol. 2019 Jan.

Abstract

Surgical closure of a patent ductus arteriosus (PDA) is considered standard treatment for symptomatic neonates refractory to medical therapy. Sometimes, iatrogenic injury to the left recurrent laryngeal nerve during the procedure can result in vocal cord paralysis (VCP). This study aimed to estimate the incidence of VCP in patients after surgical PDA closure and to identify any associated risk factors and morbidities associated with VCP in the preterm infant population. A thorough search of the major electronic databases was conducted to identify studies eligible for inclusion into this meta-analysis. Studies reporting data on the incidence of VCP (primary outcomes) or risk factors and morbidities associated with VCP in premature infant population (secondary outcomes) were included. A total of 33 studies (n = 4887 patients) were included into the analysis. Overall pooled incidence estimate of VCP was 7.9% (95%CI 5.3-10.9). The incidence of VCP after PDA closure was significantly much higher in premature infants (11.2% [95%CI 7.0-16.3]) than in non-premature patients (3.0% [95%CI 1.5-4.9]). The data showed that VCP was most common after surgical ligation and in studies conducting universal laryngoscopy scoping. The risk factors for postoperative VCP in preterm infants included birth weight and gestational age. In addition, VCP was significantly associated with the occurrence of bronchopulmonary dysplasia, gastrostomy tube insertion, and increased duration of mechanical ventilation. Vocal cord paralysis remains a frequent complication of surgical closure of a PDA, especially in premature neonates, and is associated with significant post-procedural complications.

Keywords: Meta-analysis; Patent ductus arteriosus; Recurrent laryngeal nerve injury; Vocal cord paralysis.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Study identification flowchart
Fig. 2
Fig. 2
Forest plot for overall pooled incidence rate of vocal cord paralysis
See this image and copyright information in PMC

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