Evaluating Diaphragmatic Paralysis After Pediatric Cardiac Surgery and the Role of Plication in Outcome Improvement: Insights From a Single-Center Experience.

Abstract

Introduction: Diaphragmatic paralysis (DP) is a significant complication following cardiac surgery, particularly impacting neonates and infants. This retrospective study aims to evaluate the incidence of DP, identify risk factors, and assess the impact of diaphragmatic plication as a definitive management strategy.

Methods: We analyzed the clinical records of pediatric patients who underwent cardiac surgery at our center from 2016 to 2023. Cases of DP were identified, potential risk factors examined, and the effectiveness of plication assessed. Patients were categorized into early and late groups based on the timing of DP diagnosis relative to surgery.

Results: Out of 2,331 pediatric cardiac surgery patients (median age 7.2 months), DP was identified in 60 patients (2.6%), with a higher incidence of left-sided paralysis in 37 patients (61.7%). Diaphragmatic paralysis was more frequently associated with specific procedures, such as bidirectional Glenn, arterial switch operations, and Blalock-Taussig-Thomas shunt. Patients with DP had significantly longer intensive care unit (ICU) stays (21 vs 4 days, P < .001) and total hospital stays (38 vs 11 days, P < .001). Following plication, median mechanical ventilation (MV) hours significantly decreased (73-13 h, P < .001), and ICU stays were reduced (15-3 days, P < .001). Early plication was associated with shorter MV time and hospital stays.

Conclusion: Diaphragmatic paralysis is a notable complication after cardiac surgery. Diaphragmatic plication proves to be an effective intervention, reducing MV duration and hospital stays. These findings underscore the importance of early recognition and intervention for improved postoperative outcomes.