Boutros Christina S, Elmo MaryJo, Carl Nicholas, Abu-Omar Yasir, Arora Rakesh, Elgudin Yakov, Gray Kelsey E, Pelletier Marc P, Onders Raymond P
Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
JHLT Open. 2025 May 13;9:100281. doi: 10.1016/j.jhlto.2025.100281. eCollection 2025 Aug.
Phrenic nerve dysfunction in left ventricular assist device (LVAD) implantation or heart transplant (HTx) leads to dependency on noninvasive ventilation and difficulty weaning off mechanical ventilation (MV). This study reports on diaphragm pacing (DP) to improve diaphragm function postphrenic nerve injury.
In a single-center cohort study, 2 DP systems were used in HTx or LVAD recipients. Chronic DP was laparoscopically implanted for remote phrenic dysfunction, while temporary DP was implanted percutaneously during HTx. Diaphragm function was evaluated radiographically and via electromyography.
Out of 900 patients, 10 met criteria and used DP without adverse events. Eight had chronic DP for phrenic injuries (5 HTx, 3 LVAD), with 87% recovery. Two had temporary DP at HTx; one utilized DP for weaning from MV. Early DP use facilitated rapid MV weaning.
This exploratory case series suggests a potential role for DP in patients with phrenic nerve injury following heart transplant or LVAD.
左心室辅助装置（LVAD）植入或心脏移植（HTx）过程中的膈神经功能障碍会导致患者依赖无创通气，且难以撤机。本研究报告了膈肌起搏（DP）对膈神经损伤后改善膈肌功能的作用。
在一项单中心队列研究中，2种DP系统应用于HTx或LVAD接受者。对于远端膈神经功能障碍，通过腹腔镜植入慢性DP；在HTx期间经皮植入临时DP。通过影像学和肌电图评估膈肌功能。
900例患者中，10例符合标准并使用DP，无不良事件发生。8例因膈神经损伤接受慢性DP治疗（5例HTx，3例LVAD），恢复率为87%。2例在HTx时接受临时DP；1例使用DP撤机。早期使用DP有助于快速撤机。
该探索性病例系列提示DP在心脏移植或LVAD后膈神经损伤患者中具有潜在作用。
