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.