Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 23;32(3):271-279.
doi: 10.5606/tgkdc.dergisi.2024.26103. eCollection 2024 Jul.

Diaphragmatic elevations following cardiac surgery

İsa Civelek  1 , Ayla Ece Çelikten  1 , Hamdi Mehmet Özbek  1 , Bekir Boğaçhan Akkaya  1 , Anıl Özen  1 , Ertekin Utku Unal  2 , Cemal Levent Birincioğlu  1
Affiliations

Diaphragmatic elevations following cardiac surgery

İsa Civelek et al. Turk Gogus Kalp Damar Cerrahisi Derg. .

Abstract

Background: This study aims to investigate the incidence, prognosis, and etiology of diaphragmatic elevation following cardiac surgery.

Methods: Between February 2019 and December 2019, a total of 888 patients (631 males, 257 females; mean age: 58.4±12.1 years; range, 19 to 84 years) who underwent cardiac surgery were retrospectively analyzed. A series of chest X-rays taken before and after surgery were analyzed to detect diaphragmatic elevation. The patients were divided into two groups: those without diaphragmatic elevation (Group 1, n=789) and those with diaphragmatic elevation (Group 2, n=99).

Results: Diaphragmatic elevation occurred in 11.14% of patients. Of these patients, 85% recovered within a year. Patients with concomitant chronic obstructive pulmonary disease and diaphragmatic elevation exhibited prolonged mechanical ventilation compared to chronic obstructive pulmonary disease patients without elevation. The incidence of diaphragmatic elevation was higher in coronary artery bypass grafting patients compared to others (p<0.001). A secondary analysis utilizing propensity score matching revealed topical cold slush as an independent risk factor for diaphragmatic elevation. Incidence and hospitalization duration were higher among patients exposed to topical cold slush (p=0.011 and p=0.002, respectively). Left internal mammary artery harvesting and diabetes mellitus were associated with increased incidence of diaphragmatic elevation.

Conclusion: Diaphragmatic elevation is frequent following cardiac surgery, particularly in coronary artery bypass grafting patients with diabetes mellitus. Among chronic obstructive pulmonary disease patients, diaphragmatic elevation can lead to unfavorable clinical outcomes. Minimizing the use of topical cold slush and considering beating heart surgery may be prudent in high-risk groups to reduce diaphragmatic elevation incidence.

Keywords: Cardiac surgery; coronary artery bypass grafting; mammary arteries; phrenic nerve; respiratory paralysis..

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Figure 1
Figure 1. Recovery time of diaphragmatic elevation.
Figure 2
Figure 2. Distribution of propensity scores.
See this image and copyright information in PMC

References

    1. Iñiguez CEB, Martinez MP, Wiener DC, Jaklitsch MT. In: Sabiston and Spencer Surgery of the Chest. 9. Sellke FW, del Nido PJ, Swanson SJ, editors. Philadelphia: Elsevier; 2015. Surgery of the diaphragm: A deductive approach; pp. 526–542.
    1. Fauza DO, Wilson JM. In: Sabiston and Spencer Surgery of the Chest. 9. Sellke FW, del Nido PJ, editors. Philadelphia: Elsevier; 2015. Congenital diaphragmatic hernia; pp. 543–573.
    1. Mali S, Haghaninejad H. Pulmonary complications following cardiac surgery. e280-5Arch Med Sci Atheroscler Dis. 2019;4 doi: 10.5114/amsad.2019.91432. - DOI - PMC - PubMed
    1. Kouchoukos N, Blackstone E, Hanley FL, James Kirklin. In: Kirklin/Barratt-Boyes cardiac surgery. 4. Kirklin JK, Blackstone EH, editors. Amsterdam: Elsevier; 2012. Myocardial Management during Cardiac Surgery with Cardiopulmonary Bypass; pp. 133–162.
    1. Lev-Ran O, Abrahamov D, Baram N, Matsa M, Ishai Y, Gabai O, et al. In-situ left-sided bilateral internal thoracic artery: Elevated hemidiaphragm. Asian Cardiovasc Thorac Ann. 2018;26:94–100. doi: 10.1177/0218492317754143. - DOI - PubMed

LinkOut - more resources