Tracheostomy can be avoided! Anterior-posterior cricoid split in bilateral vocal fold paralysis following complex congenital heart surgery

Children born with congenital heart disease (CHD) have an increased incidence of respiratory anomalies and complications such as bilateral vocal fold paralysis (BVFP) causing upper respiratory obstruction. Historically, two-thirds of children with BVFP have eventually required a trachesotomy.1 However, tracheostomy in children with CHD carries more than 20% risk of mortality, and less than half of patients with single-ventricle physiology with tracheostomy survive to Fontan palliation.2,3 Recently, anterior-posterior cricoid split (APCS) has been reported as a potential alternative, with 74% of patients avoiding tracheostomy.