Phrenic nerve dysfunction after cardiac operations: electrophysiologic evaluation of risk factors.

Abstract:

BACKGROUND AND STUDY OBJECTIVE:Phrenic nerve injury may occur after cardiac surgery; however, its cause has not been extensively investigated with electrophysiology. The purpose of this study was to determine by electrophysiologic means the importance of various possible risk factors in the development of phrenic nerve dysfunction after cardiac surgical operations. DESIGN:A prospective study was conducted. SETTING:A tertiary teaching hospital provided the background for the study. PATIENTS:Sixty-three cardiac surgery patients on whom surgical operations were performed by the same surgical team constituted the study group. Mean (+/-SD) age and ejection fraction were 63+/-5 years and 50+/-10%, respectively. INTERVENTIONS:Measurement of phrenic nerve conduction latency time after transcutaneous stimulation preoperatively and at 24 h and 7 and 30 days postoperatively. RESULTS:Thirteen patients had abnormal phrenic nerve function postsurgery, 12 on the left side and one bilaterally. Logistic regression analysis revealed that among the potential risk factors investigated, use of ice slush for myocardial preservation was the only independent risk factor related to phrenic nerve dysfunction (p=0.01), carrying an 8-fold higher incidence for this complication. In contrast, age, ejection fraction of the left ventricle, operative/bypass/aortic cross-clamp time, left internal mammary artery use, and diabetes mellitus were not found to be associated with phrenic neuropathy. The postoperative outcome of patients who received ice slush compared with that of those who had cold saline solution did not differ in terms of early morbidity and mortality. CONCLUSION:Among the risk factors investigated, only the use of ice slush was significantly associated with postoperative phrenic nerve dysfunction. Therefore, ice should be avoided in cardiac surgery, since it does not seem to provide additional myocardial protection.

journal_name

Chest

journal_title

Chest

authors

Dimopoulou I,Daganou M,Dafni U,Karakatsani A,Khoury M,Geroulanos S,Jordanoglou J

doi

10.1378/chest.113.1.8

subject

Has Abstract

pub_date

1998-01-01 00:00:00

pages

8-14

issue

1

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(16)39541-1

journal_volume

113

pub_type

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