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. 2023 Dec 28;11(1):8.
doi: 10.3390/jcdd11010008.

Towards Zero Phrenic Nerve Injury in Reoperative Pediatric Cardiac Surgery: The Value of Intraoperative Phrenic Nerve Stimulation

Sameh M Said  1   2 , Ali H Mashadi  3 , Mahmoud I Salem  4 , Shanti L Narasimhan  5
Affiliations

Towards Zero Phrenic Nerve Injury in Reoperative Pediatric Cardiac Surgery: The Value of Intraoperative Phrenic Nerve Stimulation

Sameh M Said et al. J Cardiovasc Dev Dis. .

Abstract

Background: Phrenic nerve injury is a devastating complication that results in significant morbidity and mortality. We developed a novel technique to localize the phrenic nerve and evaluate its success.

Methods: Two groups of children underwent repeat sternotomy for a variety of indications. Group I (69 patients, nerve stimulator) and Group II (78 patients, no nerve stimulator).

Results: There was no significant difference in the mean age and weight between the two groups: (6.4 ± 6.5 years vs. 5.6 ± 6.4 years; p = 0.65) and (25.2 ± 24.1 vs. 22.6 ± 22.1; p = 0.69), respectively. The two groups were comparable in the following procedures: pulmonary conduit replacement, bidirectional cavopulmonary anastomosis, aortic arch repair, and Fontan, while Group I had more pulmonary arterial branch reconstruction (p = 0.009) and Group II had more heart transplant patients (p = 0.001). There was no phrenic nerve injury in Group I, while there were 13 patients who suffered phrenic nerve injury in Group II (p < 0.001). No early mortality in Group I, while five patients died prior to discharge in Group II. Eleven patients underwent diaphragm plication in Group II (p = 0.001). The mean number of hours on the ventilator was significantly higher in Group II (137.3 ± 324.9) compared to Group I (17 ± 66.9), p < 0.001. Group II had a significantly longer length of ICU and hospital stays compared to Group I (p = 0.007 and p = 0.006 respectively).

Conclusion: Phrenic nerve injury in children continues to be associated with significant morbidities and increased length of stay. The use of intraoperative phrenic nerve stimulator can be an effective way to localize the phrenic nerve and avoid its injury.

Keywords: Peña stimulator; diaphragm paralysis; diaphragm plication; nerve stimulation; phrenic nerve injury.

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Conflict of interest statement

The first author (S.M.S.) is a consultant for Artivion, JOMDD, and Abbott.

Figures

Figure 1
Figure 1
The Peña stimulator provides constant current and was used to localize the phrenic nerve in the current study with a high degree of accuracy.
Figure 2
Figure 2
The Peña stimulator has a bipolar hand-held probe which is reusable and easy to use inside the chest cavity.
Figure 3
Figure 3
An alternative to the Peña stimulator is a disposable hand-held nerve stimulator that can be used in the same fashion and produces the same results.
Figure 4
Figure 4
The stimulator/power supply component of the Peña stimulator. The output of the device can be adjusted to achieve the best stimulation at the lowest output.
Figure 5
Figure 5
Graphical representation of the method and results in the current study.
See this image and copyright information in PMC

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