Utility of fiberoptic endoscopic evaluation of swallowing in patients
undergoing left ventricular assist device implantation
Abstract
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.