Background: Dysphagia following cardiac surgery is common and associated with adverse outcomes. Among patients receiving left ventricular assist device (LVAD), we evaluated the impact of fiberoptic endoscopic evaluation of swallowing (FEES) on outcomes. Methods: A single-center pilot study was conducted in adults (≥18 years of age) undergoing durable LVAD (February 2019-January 2020). Six patients were prospectively enrolled, evaluated, and underwent FEES within 72 hours of extubation—they were compared to 12 control patients. Demographic, surgical, and postoperative outcomes were collected. Unpaired two-sided t-tests and Fisher’s Exact tests were performed. Results: Baseline characteristics were similar between groups. Intraoperative criteria including duration of transesophageal echo (314 ± 86 min) and surgery (301 ± 74 min) did not differ. Mean time of intubation was comparable (57.3 vs. 68.7 hours, p=0.77). In the entire cohort, 30-day, 1-year, 2-year, and 3-year mortality were 0%, 5.6%, 5.6%, and 16.7%, respectively. Sixty-seven percent of the patients that underwent FEES had inefficient swallowing function. The FEES group trended to a shorter hospital length of stay (LOS) (29.1 vs. 46.6 days, p=0.098), post-implantation LOS (25.3 vs 30.7 days, p=0.46), and lower incidence of postoperative pneumonia (16.7% vs. 50%, p=0.32) and sepsis (0% vs. 33.3%, p=0.25). Conclusions: FEES did not impact 30-day, 1-year, 2-year, or 3-year mortality. Patients who underwent FEES trended toward shorter LOS, and lower postoperative pneumonia and sepsis rates, though not statistically significant. A higher incidence of dysphagia among patients undergoing FEES despite comparable baseline risk factors with controls suggests FEES may detect subclinical dysphagia.
A kyphotic gentleman with chronic obstructive pulmonary disease and Marfan syndrome whose history was significant for thoracoabdominal aortic replacement secondary contained rupture, presented with chest pain and an acute DeBakey type I aortic dissection. In this anatomically challenging total arch replacement, Cor-Knot fastener was employed without short-term or long-term complications.