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J Thorac Cardiovasc Surg 2006;132:530-536
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Electrophysiologic evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: Prospective study of diabetes and other risk factors

^a Department of Clinical Neurophysiology, Ribera Hospital, Alzira, Valencia, Spain
^b Department of Medicine, Faculty of Medicine, University of Valencia, Valencia, Spain
^e Department of Clinical Pharmacology, Faculty of Medicine, University of Valencia, Valencia, Spain
^c Service of Pneumology, University General Hospital Consortium, Valencia, Spain
^d Research Foundation, University General Hospital Consortium, Valencia, Spain
^f Service of Cardiac Surgery, La Fe University Hospital, Valencia, Spain.

Received for publication March 7, 2006; revisions received April 19, 2006; accepted for publication May 12, 2006.

^_* Address for reprints: Esteban J. Morcillo, MD, PhD, Department of Clinical Pharmacology, Faculty of Medicine, Avda. Blasco Ibáñez, 15, E-46010 Valencia, Spain (Email: Gustavo.Juan{at}uv.es).

OBJECTIVE: Phrenic neuropathy after coronary artery bypass grafting has been related to various risk factors with conflicting results. The aim of this study was to assess the incidence, characteristics, and clinical consequences of phrenic neuropathy and the influence of diabetes and other risk factors.

METHODS: We conducted an observational, prospective study of parallel groups including 94 consecutive patients subjected to coronary artery bypass grafting, half of them with diabetes and associated polyneuropathy. Electrophysiologic study of phrenic nerve conduction as the reference method, chest radiography, diaphragm ultrasound, and functional respiratory tests were performed 24 to 48 hours before and 7 days after surgery. In those patients showing phrenic neuropathy, explorations were repeated, including needle diaphragmatic electromyography, at 1, 3, 6, 9, 12, 18, and 24 months or until recovery.

RESULTS: Fifteen of the 94 patients (16%) had phrenic neuropathy, 9 in the left side, 3 on the right, and 3 bilateral. Nine (60%) of the affected patients had diabetes, but diabetes did not represent a greater risk of neuropathy (relative risk 1.5, 95% confidence interval 0.6-3.9). Multivariate analysis showed no association of phrenic nerve injury with age, sex, ejection fraction, diabetes, use of internal thoracic artery, or number of grafts as risk factors. Phrenic neuropathy did not result in greater morbidity, and most patients recovered in less than 1 year.

CONCLUSIONS: None of the risk factors studied, including diabetes, influenced the appearance of phrenic neuropathy, thus indicating a role for nerve damage during surgery. Low morbidity and relatively rapid recovery were observed.

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