Diaphragmatic palsy. A common complication after lvad implantation

Abstract Introduction Diaphragm palsy following cadiothoracic surgery affects outcomes. Its prevalence, persistence and impact after LVAD implantation are unkown. Methods In this combined retrospective—prospective cohort study 137 Diaphragm ultrasound studies (DUS) were performed in 101 LVAD patients between January 2022 and August 2024. Diaphragm function was assessed with M-mode ultrasound based on its excursion on regular, forced and sniff inspiration. In 18 patients assessment was performed before LVAD, 50 patients had DUS performed inhospitally early after LVAD (early subgroup) and in 69 patients after long term observation (late subgroup). Results There was no case of bilateral palsy. Majority had 64,5% had left side palsy. Among 18 patients having DUS pre and early and late post LVAD only left diphraghm movement was affected significantly. The decreased mobility was persistent over time (Table 1). Early subgroup Diaphagm palsy occured in majority (62% vs 38% ) early after at mean time of 9 ±7 days after LVAD implantation. Patients with palsy were significantly younger (45 IQ 34-59 VS 61 IQ 49-63 years, p=0.006) with higher baseline creatinine level (1,29 mg% IQ 1,14-1,57 vs 1,1 (0,97-1,33) and greater pulmonary wedge pressure (30,1± 6,3 mmHg vs 24,1 ± 9,6 p=0.008). There was tendency towards longer bypass time (91,4 min ± 28,6 vs 79,4 min ± 15,0;p=0.062) Other potential risk factor such as INTERMACS scale, preLVAD mechanical circulatory support were insignificant. Late subgroup Diaphagm palsy was present in minority (11%) after mean time of 794 ±693 days from LVAD implantation. 6 minute walk distance was significantly shorter in patients with palsy 330 ± 84,7 m vs 445 ±50,6 in patients with palsy; p=0.001) Conclusion Diaphragm palsy is : a common early complication after LVAD implantation; a potential risk factor for pneumonia, prolonged ITU stay and respiratory insufficiency; a potentially reversible (early rate 62% vs late 11%); if persistent may affect long term performance.