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Midterm Results of Minimally Invasive Diaphragm Plication for Diaphragm Paralysis
October 2012, Vol 142, No. 4_MeetingAbstracts Cardiothoracic Surgery | October 2012
Midterm Results of Minimally Invasive Diaphragm Plication for Diaphragm Paralysis David Odell*, MD; Jonathan D'Cunha, MD; Teri Kast, RN; Michael Maddaus, MD; Raphael Andrade, MD University of Minnesota, Minneapolis, MN
Chest. 2012;142(4_MeetingAbstracts):62A. doi:10.1378/chest.1391831
Abstract SESSION TYPE: Thoracic Surgery Posters I PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM PURPOSE: Hemidiaphragm paralysis can result in significant disability. Short term results for minimally invasive surgical diaphragm plication appear promising, but the durability of the operation is not defined. We present the mid term results of a minimally invasive approach to diaphragm plication. METHODS: We performed a retrospective review of all symptomatic patients operatively treated for diaphragm paralysis or eventration at our institution from April 2007 through December 2009. Patients treated thoracoscopically or laparoscopically were included. Pulmonary function testing was performed preoperatively, postoperatively and at yearly intervals with change assessed over time. Symptomatic impact was assessed by administration of the St George’s Respiratory Questionnaire (SGRQ) at corresponding time intervals.
RESULTS: A total of 11 patients (6 left side, 5 right side) underwent laparoscopic or thoracoscopic diaphragm plication during the study period. Postoperative improvement was seen in all measused pulmonary function variables (upright FVC 54.7% preoperative vs 58.3% postoperative and 49.3% vs 55.9% supine; FEV-1 48.7% vs 52.2%; maximal FIF 99% vs 105.2%). Mean upright FVC increased from a baseline value of 54.7 % predicted to 60.2% at one year (p=0.08) and 57.5% at 2 years. In the supine position, a similar trend was seen and remained significant at 2 years (58.3% p=0.02). A clinically important increase from baseline FEV-1 was seen at 1 year (56.8%) and remained at 2 years (51.2%). The mean baseline SGRQ score was 62.6 and improved over time with a reduction in SGRQ of 24.1 points postoperatively, 32.3 at 1 year and 12.8 at 2 years. A change in SGRQ of ≥4 points is considered clinically important. No immediate or late operative complications were seen. CONCLUSIONS: Minimally invasive diaphragm plication can be performed safely and results in a durable improvement in pulmonary function. Most importantly, improvement in patient reported symptoms is also seen 2 years following surgical intervention. Further long-term follow-up is needed to confirm these findings in a larger patient cohort. CLINICAL IMPLICATIONS: Operative diaphragm plication should be considered for symptomatic patients with hemidiaphragm paralysis or eventration. DISCLOSURE: The following authors have nothing to disclose: David Odell, Jonathan D'Cunha, Teri Kast, Michael Maddaus, Raphael Andrade No Product/Research Disclosure Information University of Minnesota, Minneapolis, MN
Midterm Results of Minimally Invasive Diaphragm Plication for Diaphragm Paralysis David Odell*, MD; Jonathan D'Cunha, MD; Teri Kast, RN; Michael Maddaus, MD; Raphael Andrade, MD University of Minnesota, Minneapolis, MN
Chest. 2012;142(4_MeetingAbstracts):62A. doi:10.1378/chest.1391831
Abstract SESSION TYPE: Thoracic Surgery Posters I PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM PURPOSE: Hemidiaphragm paralysis can result in significant disability. Short term results for minimally invasive surgical diaphragm plication appear promising, but the durability of the operation is not defined. We present the mid term results of a minimally invasive approach to diaphragm plication. METHODS: We performed a retrospective review of all symptomatic patients operatively treated for diaphragm paralysis or eventration at our institution from April 2007 through December 2009. Patients treated thoracoscopically or laparoscopically were included. Pulmonary function testing was performed preoperatively, postoperatively and at yearly intervals with change assessed over time. Symptomatic impact was assessed by administration of the St George’s Respiratory Questionnaire (SGRQ) at corresponding time intervals.
RESULTS: A total of 11 patients (6 left side, 5 right side) underwent laparoscopic or thoracoscopic diaphragm plication during the study period. Postoperative improvement was seen in all measused pulmonary function variables (upright FVC 54.7% preoperative vs 58.3% postoperative and 49.3% vs 55.9% supine; FEV-1 48.7% vs 52.2%; maximal FIF 99% vs 105.2%). Mean upright FVC increased from a baseline value of 54.7 % predicted to 60.2% at one year (p=0.08) and 57.5% at 2 years. In the supine position, a similar trend was seen and remained significant at 2 years (58.3% p=0.02). A clinically important increase from baseline FEV-1 was seen at 1 year (56.8%) and remained at 2 years (51.2%). The mean baseline SGRQ score was 62.6 and improved over time with a reduction in SGRQ of 24.1 points postoperatively, 32.3 at 1 year and 12.8 at 2 years. A change in SGRQ of ≥4 points is considered clinically important. No immediate or late operative complications were seen. CONCLUSIONS: Minimally invasive diaphragm plication can be performed safely and results in a durable improvement in pulmonary function. Most importantly, improvement in patient reported symptoms is also seen 2 years following surgical intervention. Further long-term follow-up is needed to confirm these findings in a larger patient cohort. CLINICAL IMPLICATIONS: Operative diaphragm plication should be considered for symptomatic patients with hemidiaphragm paralysis or eventration. DISCLOSURE: The following authors have nothing to disclose: David Odell, Jonathan D'Cunha, Teri Kast, Michael Maddaus, Raphael Andrade No Product/Research Disclosure Information University of Minnesota, Minneapolis, MN