Long-Term Follow-Up of the Functional and Physiologic Results of Diaphragm Plication in Adults With Unilateral Diaphragm Paralysis

• Published in: The Annals of thoracic surgery Vol. 88; no. 4; pp. 1112 - 1117
• Main Authors: Freeman, Richard K., MD, Van Woerkom, Jaclyn, RN, BSN, Vyverberg, Amy, RN, BSN, Ascioti, Anthony J., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.10.2009
• Subjects: Adult; Cardiothoracic Surgery; Diaphragm - physiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Recovery of Function - physiology; Respiratory Function Tests; Respiratory Paralysis - physiopathology; Respiratory Paralysis - surgery; Retrospective Studies; Surgery; Thoracic Surgical Procedures - methods; Time Factors; Treatment Outcome; 6
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2009.05.027

Background Patients with lifestyle-limiting dyspnea attributable to unilateral diaphragm paralysis have been shown to experience a decrease in their dyspnea and an improvement in their pulmonary spirometry and functional status with diaphragm plication acutely after surgery. This investigation summarizes these patients' outcomes with long-term follow-up. Methods Adult patients undergoing plication of the hemidiaphragm for lifestyle-limiting dyspnea secondary to unilateral diaphragm paralysis were assessed preoperatively, 6 month after surgery and then annually using the Medical Research Council dyspnea score, pulmonary spirometry, activities of daily living questionnaire, and a chest radiograph. Patients with at least 48 months of follow-up were included in this investigation. Results Forty-one patients underwent plication of the hemidiaphragm through video-assisted thoracoscopy (30) or thoracotomy (11). Mean follow-up was 57 ± 10 months. Mean forced vital capacity, forced expiratory volume at 1 second, functional residual capacity, and total lung capacity all improved by 19%, 23%, 21%, and 19% ( p < 0.005), respectively, when measured 6 months after surgery, as were mean Medical Research Council dyspnea scores ( p < 0.0001). These mean values remained constant over the follow-up period. Four patients did not show improvement in their Medical Research Council dyspnea scores nor functional status despite improvements in their pulmonary spirometry values. Two of these patients had a body mass index greater than 35 kg/m2 and 3 had documented unilateral diaphragm paralysis for at least 4 years before plication. Conclusions Plication of the hemidiaphragm produces improvement for the vast majority of patients in pulmonary spirometry, dyspnea, and functional status that endures over long-term follow-up. Patients who are morbidly obese or who have longstanding unilateral diaphragm paralysis may not realize the same benefits of plication.