Among individuals undergoing common cardiovascular procedures, those with a preoperative diagnosis of dysphagia face an increased risk of postoperative mortality and complications, according to a retrospective study.
In propensity-score matched cohorts, dysphagia independently predicted lower probability of survival at 90 days and at 1 year following coronary artery bypass grafting (CABG; hazard ratios [HRs], 1.32 and 1.42, respectively; p=0.0006 and p<0.0001), implantable cardioverter‐defibrillator (ICD) implantation (HRs, 1.40 and 1.22, respectively; p=0.0025 and p=0.0035), transcatheter aortic valve replacement (TAVR; HRs, 1.74 and 1.42, respectively; p<0.0001 for both), and surgical aortic valve replacement (SAVR; HRs, 1.34 and 1.39, respectively; p=0.0075 and p=0.0004). [J Am Heart Assoc 2026;doi:10.1161/JAHA.126.049122]
Similarly, dysphagia was associated with increased risks of developing stroke, infectious pneumonia, and hypoxemia at 90 days postoperatively across all cardiovascular procedures. For example, patients with vs without dysphagia had a substantially higher 90‐day stroke risk following CABG (9.5 percent vs 6 percent; risk ratio [RR], 1.60; p<0.0001), ICD implantation (7 percent vs 4.7 percent; RR, 1.50; p<0.0001), TAVR (8 percent vs 6.2 percent; RR, 1.29; p=0.002), SAVR (12.8 percent vs 8.9 percent; RR, 1.44; p<0.0001), and mitral transcatheter edge‐to‐edge repair (mTEER; 7.9 percent vs 4.8 percent; RR, 1.65; p=0.002).
The elevated postoperative risks of stroke, infectious pneumonia, and hypoxemia among patients with dysphagia persisted at 1 year across all cardiovascular procedures.
In addition to the complications mentioned, dysphagia was associated with significantly higher postoperative risks of intubation and aspiration pneumonia at 1 year.
“Collectively, these findings identify dysphagia as a clinically relevant prognostic factor in cardiovascular surgical populations, regardless of the procedure type,” said first study author Anagh Astavans from the Johns Hopkins University, Baltimore, Maryland, US, and colleagues.
“The mechanisms underlying these associations likely involve a convergence of biological frailty, neurogenic dysfunction, and procedural stress. Dysphagia reflects underlying physiologic vulnerability capturing features of frailty, such as sarcopenia, malnutrition, and diminished cardiopulmonary reserve, all of which impair recovery from major surgery,” they explained.
Astavans and colleagues discussed the practical implications of recognizing dysphagia as a cardiovascular surgical risk factor. They pointed out that incorporating swallow screening into standard preoperative risk assessments could improve identification of high‐risk patients and facilitate targeted multidisciplinary interventions.
In routine practice, the availability of brief validated tools, such as the Eating Assessment Tool‐10, “provide a simple, patient‐reported method to detect swallowing difficulty with minimal resource burden in both inpatient and outpatient settings,” the authors said.
For the study, Astavans and colleagues used data from the TriNetX database and established propensity-score matched pairs of patients with and without dysphagia. A total of 5,125 pairs underwent CABG, 4,038 underwent ICD implantation, 4,013 underwent TAVR, 1,955 underwent SAVR, and 695 had mTEER.