Management of Phrenic Nerve Injury During Cardiac Surgery

Clinical Presentation and Diagnosis

• Phrenic nerve injury presents with symptoms of hemidiaphragmatic paralysis, which can be identified by immobility or elevation of the diaphragm on imaging 2, 3

Risk Factors and Prevention

• Injury mechanisms include direct trauma, traction, thermal injury, and is more common during redo operations and concurrent Cox-maze procedures 1
• Preventive strategies include careful pericardial incision, especially when entering near the pulmonary vein-LA junction 4
• Visual identification of the nerve during dissection can help prevent injury 1

Management Algorithm

• Most adult patients can be managed conservatively with respiratory support 1
• Patients who fail to wean from mechanical ventilation or experience respiratory distress may require early diaphragmatic plication, especially younger patients 1

Expected Outcomes and Complications

• Most phrenic nerve injuries will recover within 3-6 months if the nerve is not transected 1
• Diaphragm function typically improves with time, with most recovery occurring within 3-6 months 1