The advantage of early plication in children diagnosed with diaphragm paresis

Floh, Alejandro A.; Zafurallah, Intikhab; MacDonald, Cathy; Honjo, Osami; Fan, Chun‐Po Steve; Laussen, Peter C.

doi:10.1016/j.jtcvs.2017.05.109

Cited by 22 publications

(18 citation statements)

References 13 publications

(19 reference statements)

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“…They found that the two greatest predictors of requiring diaphragm plication were younger age and undergoing deep hypothermic circulatory arrest. 9 The incidence of diaphragm plication in our population also increased with increasing surgical complexity as defined by Risk Adjustment for Congenital Heart Surgery score. Patients with a Risk Adjustment for Congenital Heart Surgery score of 5 or 6 were much more likely to undergo plication than those with a Risk Adjustment for Congenital Heart Surgery score of 1.…”

Section: Discussionmentioning

confidence: 85%

“…Floh et al found that the highest incidence of diaphragm plication occurred in patients undergoing arch repair, ventricular septal defect/arch repair, or coarctation repair followed by tetralogy of fallot/right ventricular outflow tract obstruction repair and arterial switch operation. 9 Other studies have found that the incidence of dysfunction requiring plication was higher following the Blalock-Taussig shunt, tetralogy of fallot repair, and the arterial switch operation. 3,6 The definitive procedure for diaphragm dysfunction is plication of the diaphragm.…”

Section: Discussionmentioning

confidence: 95%

“…This incidence is within the reported range of 0.3-12.8% found in other studies. 3,9,10 The innervation to the diaphragm is particularly vulnerable to cardiac surgery due to extensive resection in the area of the phrenic nerve as well as cooling protocols required for surgery. Both adults and children are at risk for phrenic nerve injury post-cardiac surgery, 4 although the effects on children are much more significant due to the impact of the diaphragm on respiratory function.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

et al. 2019

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Background:Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.Methods:We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.Results:Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.Conclusions:Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

et al. 2019

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“…Furthermore, many reports have shown that diaphragmatic plication (DPL) for DP can improve the respiratory status and facilitate early weaning in ventilated children. The selection of pediatric patients who should undergo plication, however, remains controversial …”

Section: Introductionmentioning

confidence: 99%

“…The selection of pediatric patients who should undergo plication, however, remains controversial. 4 The purposes of the present study were to describe the etiologies of DP, with emphasis on noncardiac surgery-related causes, and to determine the risk factors and predictors for the requirement of DPL in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Predictors for plication performance following diaphragmatic paralysis in children

Goldberg

Krauthammer

Ashkenazi

et al. 2019

Pediatric Pulmonology

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Introduction and Objectives Diaphragmatic paralysis (DP) in children can result from various etiologies. Guidelines for patient selection for diaphragmatic plication (DPL) are lacking. Our objectives were to describe the etiologies of DP and to determine the risk factors and predictors for DPL in the pediatric population. Methods Retrospective data were retrieved from departmental databases on patients with DP from the pediatric, cardiac, and neonatal intensive care departments of Safra Children's Hospital from 2010 to 2017. Results DP was diagnosed in 88 patients, 29 with noncardiac surgery‐related etiologies, for example, congenital, surgery, trauma, and shock and 59 with cardiac surgery‐related etiologies. In total, 27 (31%) patients underwent DPL, and they had significant comorbidities involving respiratory, central nervous, and cardiovascular systems, higher lung injury scores, and lower weight compared with the patients who did not undergo DPL (P = .002, P = .002, P < .001, P = .012, and P = .013, respectively). A multivariate regression model revealed significant independent predictors for DPL, including morbidities of central nervous (odds ratio [OR = 9.651, P = .005), respiratory (OR = 4.875, P = .039), and cardiovascular systems (OR = 23.938, P = .001). Conclusions Etiologies of DP are very diverse in the pediatric population. Comorbidities of respiratory, central nervous, and cardiovascular systems are risk factors for plication requirement in respiratory support‐dependent pediatric patients with DP. Early DPL should be considered in these patients.

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General Aspects in the Pathology of the Diaphragm

Asban

Wei

2020

Thoracic Surgery

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The advantage of early plication in children diagnosed with diaphragm paresis

Abstract: Early plication should be considered for patients with diaphragm paresis requiring prolonged respiratory support after cardiac bypass surgery. Longer follow-up evaluation is required to better define the long-term implications of plication.

Cited by 22 publications

References 13 publications

Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

Predictors for plication performance following diaphragmatic paralysis in children

General Aspects in the Pathology of the Diaphragm

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