(1042) Laryngotracheal Anomalies in Pediatric Congenital Heart Disease Surgical Patients

Introduction: Pediatric patients with congenital heart disease (CHD) undergoing cardiac surgery have an increased risk of both congenital and acquired laryngotracheal anomalies (LAs), contributing to significant morbidity in this population. The primary aim of this study is to investigate the risk factors associated with LAs in pediatric patients undergoing cardiac surgery for CHD and to examine their effects on clinical outcomes.

Methods: In total, 184 pediatric patients who underwent surgery for CHD at a single institution between 2020 and 2021 were retrospectively analyzed. Patients were noted to have a LA if vocal fold paralysis (VFP), laryngo/tracheomalacia, scar/stenosis, or other abnormalities were found on bedside flexible laryngoscopy or MDLB. Complex cardiac surgery was defined by involving total body cooling, circulatory arrest/regional perfusion, delayed sternal closure, and/or had an extended cardiopulmonary bypass or aortic cross-clamp duration.

Results: Of the total, 36 patients (mean age at surgery 5.3 months, range 0.07-35.7 months; 55% male) exhibited LAs —22 with VFP and 25 with other anomalies. Patients who underwent coarctation of the aorta surgery were significantly associated with both VFP (p < 0.0001) and non-VFP LAs (p < 0.0001). Presence of LAs correlated with prolonged intubation with extubation in PICU compared to the OR (p = 0.0018). Complex cardiac surgeries were associated with airway trauma (p = 0.0158). For the 8 patients that required ENT-related surgical interventions, univariate analysis showed association with craniofacial syndromes (p = 0.0425) and prolonged intubation with extubation in PICU (p = 0.0262). Presence of LAs were associated with longer PICU length of stay (LOS) (11 vs 6.3 days, p = 0.0002) and hospital LOS (23.3 vs 9.4 days, p < 0.0001).

Conclusions: In pediatric CHD surgical patients, factors such as coarctation of the aorta repair and complex surgeries were associated with LAs and airway trauma, respectively. These anomalies contributed to poorer clinical outcomes, including prolonged PICU and hospital stays, underscoring the importance of early identification and management.