Is Phrenic Nerve Dysfunction After Cardiac Surgery Related to Internal Mammary Harvesting?

Tripp, Henry F.; Sees, David W.; Lisagor, Philip; Cohen, David J.

doi:10.1111/j.1540-8191.2001.tb00512.x

Cited by 20 publications

(13 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In particular, coronary artery bypass grafting (CABG) surgery is frequently associated with lesions of the phrenic nerves resulting in post-operative diaphragmatic paralysis, with incidences reported as varying from 1% to 60% [7,8,9,10,11]. One of the reasons for this wide estimate probably lies in the various surgical techniques used during CABG: harvesting of the internal mammary artery (IMA) and the use of topical ice slush for cardiac cooling are associated with an increased risk of phrenic injury [7,9,10,11,12,13,14], the former because of the close anatomical relationship of the nerve and the IMA and the latter because of the traumatic demyelinating injury to the phrenic nerved induced by the cold temperature. …”

Section: Etiology Of Diaphragmatic Dysfunctionmentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

144

109

View full text Add to dashboard Cite

The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.

show abstract

Section: Etiology Of Diaphragmatic Dysfunctionmentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

144

109

View full text Add to dashboard Cite

show abstract

“…Efthimiou demonstrated that phrenic nerve injury developed in an ice-slush application group compared to a control group (no ice-slush application) [2]. Sternal retraction, left internal mammary artery (LIMA) harvesting and central venous catheterization have also been implicated [5,6,9-11]. All studies had been performed in relation to cardiopulmonary bypass (CPB) operations.…”

Section: Introductionmentioning

confidence: 99%

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

et al. 2004

View full text Add to dashboard Cite

BackgroundAccording to some reports, left hemidiaphragmatic paralysis due to phrenic nerve injury may occur following cardiac surgery. The purpose of this study was to document the effects on phrenic nerve injury of whole body hypothermia, use of ice-slush around the heart and mammary artery harvesting.MethodsElectrophysiology of phrenic nerves was studied bilaterally in 78 subjects before and three weeks after cardiac or peripheral vascular surgery. In 49 patients, coronary artery bypass grafting (CABG) and heart valve replacement with moderate hypothermic (mean 28°C) cardiopulmonary bypass (CPB) were performed. In the other 29, CABG with beating heart was performed, or, in several cases, peripheral vascular surgery with normothermia.ResultsIn all patients, measurements of bilateral phrenic nerve function were within normal limits before surgery. Three weeks after surgery, left phrenic nerve function was absent in five patients in the CPB and hypothermia group (3 in CABG and 2 in valve replacement). No phrenic nerve dysfunction was observed after surgery in the CABG with beating heart (no CPB) or the peripheral vascular groups. Except in the five patients with left phrenic nerve paralysis, mean phrenic nerve conduction latency time (ms) and amplitude (mV) did not differ statistically before and after surgery in either group (p > 0.05).ConclusionsOur results indicate that CPB with hypothermia and local ice-slush application around the heart play a role in phrenic nerve injury following cardiac surgery. Furthermore, phrenic nerve injury during cardiac surgery occurred in 10.2 % of our patients (CABG with CPB plus valve surgery).

show abstract

“…We found 272 cases of DD (7.6%). Individuals with DD had more arterial hypertension (64.3% vs. 52.6%; p<0.0001), higher body mass index (BMI) (28 [25][26][27][28][29][30] kg/m2 vs. 26 [24][25][26][27][28][29] kg/m2; p<0.0002) and higher incidence of coronary bypass grafting (58.8% vs. 46.6%; p=0.0001). DD was associated with more postoperative pneumonia (23.9% vs. 8.7%; p<0.0001), reintubation (8.8% vs. 2.9%; p<0.0001), tracheotomy (3.3% vs. 0.3%; p<0.0001), non-invasive ventilation (45.6% vs. 5.4%; p<0.0001), duration of mechanical ventilation (5 [4][5][6][7][8][9][10][11] h vs. 4 [3][4][5][6] h; p<0.0001), and ICU and hospital stays (14 [11][12][13][14][15][16][17] days vs. 13 [11][12][13][14][15][16] days; p<0.0001).…”

Section: Resultsmentioning

confidence: 99%

Diaphragm Paralysis After Cardiac Surgery: A Frequent Cause of Post-Operative Respiratory Failure

Laghlam¹,

Lê²,

Srour³

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundDiaphragmatic dysfunction (DD) is found in 1.2-60% of patients after cardiac surgery. The aim of this study was to reinvestigate the incidence, risk factors and outcomes of DD with actual cardiac surgery procedures.MethodsThis is an observational study based on a prospectively collected database in one cardiac surgery centre. The DD group included patients with clinically perceptible diaphragmatic paralysis, which was confirmed by chest ultrasound (amplitude of the diaphragm movement in time-motion mode [TM] at rest, after a sniff test). The primary endpoint was the incidence of DD. ResultsA total of 3577 patients were included between January 2016 and September 2019. We found 272 cases of DD (7.6%). Individuals with DD had more arterial hypertension (64.3% vs. 52.6%; p<0.0001), higher body mass index (BMI) (28[25–30] kg/m2 vs. 26[24-29] kg/m2; p<0.0002) and higher incidence of coronary bypass grafting (58.8% vs. 46.6%; p=0.0001). DD was associated with more postoperative pneumonia (23.9% vs. 8.7%; p<0.0001), reintubation (8.8% vs. 2.9%; p<0.0001), tracheotomy (3.3% vs. 0.3%; p<0.0001), non-invasive ventilation (45.6% vs. 5.4%; p<0.0001), duration of mechanical ventilation (5[4-11] h vs. 4[3-6] h; p<0.0001), and ICU and hospital stays (14[11-17] days vs. 13[11–16] days; p<0.0001). In multivariate analysis, DD was associated with coronary artery bypass grafting (OR=1.9[1.5-2.6]; p=0.0001), arterial hypertension (OR=1.4[1.1- 1.9]; p=0.008), and BMI (OR per point =1.04[1.01-1.07] kg/m2; p=0.003).ConclusionThe incidence of symptomatic DD after cardiac surgery was 7.6%, leading to respiratory complications and increased ICU stay. Coronary bypass grafting was the principal factor associated with DD.

show abstract

Is Phrenic Nerve Dysfunction After Cardiac Surgery Related to Internal Mammary Harvesting?

Abstract: This study suggests IMA harvesting is indeed a risk factor for PND following CABG.

Cited by 20 publications

References 11 publications

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

Diaphragm Paralysis After Cardiac Surgery: A Frequent Cause of Post-Operative Respiratory Failure

Contact Info

Product

Resources

About