Profiling swallowing safety impairments, dysphagia severity, and risk factors for postoperative aspiration in heart transplant recipients

Pretransplant frailty and postoperative dysphagia significantly contribute to morbidity and mortality in heart transplant (HT) recipients. Therefore, we aimed to profile postoperative swallowing safety impairments, overall dysphagia severity, and risk factors for aspiration in HT recipients. We performed a retrospective cohort study of adults who underwent HT and were clinically referred for a postoperative instrumental swallow evaluation (videofluoroscopy, flexible endoscopic evaluation of swallowing) at a large academic medical center between 2018 and 2024 by extracting demographics, perioperative characteristics, and swallowing data (Dysphagia Outcome and Severity Scale scores and worst Penetration-Aspiration Scale scores) from the electronic medical record. Descriptive statistics and logistic regression models (odds ratios, 95% confidence intervals) were performed. One hundred thirty-four adults underwent HT and a postoperative instrumental swallow evaluation on the basis of clinical referral. Postoperative swallowing safety profiles were: 13% safe, 87% unsafe (33% penetration, 54% aspiration) with 93% of aspirators noted to have an ineffective or absent cough. Postoperative dysphagia severity profiles were 1% within functional limits, 99% mild or greater dysphagia severity. No statistically significant independent risk factors for postoperative aspiration were identified and no statistically significant associations between aspiration and health-related outcomes were noted. These data reveal high rates of swallowing safety impairments in this cohort of HT recipients postoperatively. Future research is needed to determine rates of pre-existing dysphagia and to establish the need for pre- and postoperative swallowing evaluations to promote postoperative recovery in this patient population.