Introduction
Postoperative aspiration and dysphagia is an increasingly common, yet
understudied, complication post cardiac surgery and has been reported in
up to 67% of cases.1–5 Dysphagia is characterized by
impairments in swallowing efficiency (inability to adequately propel
food and liquid from the mouth to the stomach) and swallowing safety
(inability to protect the airway during swallowing), leading to
aspiration of ingested materials into the trachea and pulmonary
tract.6 Consequences of dysphagia following cardiac
surgery include malnutrition reintubation, increased hospital length of
stay (LOS), and aspiration pneumonia.6 Although
preventable, the latter represents the leading cause of morbidity
following open heart surgery.7,8 Previous studies have
suggested that timely diagnosis of dysphagia is critical to prevent
devastating aspiration events.9
The use of flexible endoscopy to evaluate dysphagia, fiberoptic
endoscopic evaluation of swallowing (FEES), has been shown to be a safe,
convenient, and effective tool for evaluating
dysphagia.10–17 Notably, when compared to the
modified barium swallow (MBS) study, numerous studies have demonstrated
that FFES has greater or equal sensitivity to detect key swallowing
parameters: delay in swallowing initiation, penetration, aspiration, and
pharyngeal residue.18–21 Additionally, FEES has been
suggested to more frequently identify penetration and aspiration
compared to MBS.11,20 Furthermore, FEES is an
attractive alternative to conventional video fluoroscopy for evaluating
dysphagia due to its portability and absence of radiation exposure, and
potential to reduce the incidence of aspiration
pneumonia.10
We conducted a single-center prospective pilot study to evaluate the
impact of FEES on health-related outcomes among patients undergoing
durable left ventricular assist device (LVAD) implantation.
Specifically, we aimed to assess the incidence of developing dysphagia
and related postoperative outcome measures between patients that
underwent FEES and a cohort of matched control patients with similar
baseline risk factors.