Diaphragm Dysfunction after Coronary Artery Bypass Grafting is Associated with Increased Postoperative Morbidity
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0125
Submission Type:
Abstract Submission
Authors:
William Mitchell (1), Sameer Singh (1), Alice Vinogradsky (1), Darina Kirilina (1), Marco Tagliafierro (1), Paul Kurlansky, MD (1), Koji Takeda (1), Craig Smith (1), Syed Raza (1)
Institutions:
(1) NewYork- Presbyterian/Columbia University Medical Center, New York, NY
Submitting Author:
William Mitchell
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
Co-Author(s):
Sameer Singh
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
Alice Vinogradsky
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
Darina Kirilina
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
Marco Tagliafierro
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
*Paul Kurlansky, MD
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
*Koji Takeda
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
*Craig Smith
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
Syed Raza
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
Presenting Author:
William Mitchell
-
Contact Me
NewYork- Presbyterian/Columbia University Medical Center
NewYork- Presbyterian/Columbia University Medical Center
Abstract:
Objective: We sought to describe the incidence, postoperative outcomes, and rate of recovery in CABG patients who develop postoperative diaphragm dysfunction (DD).
Methods: Patients at a single institution who underwent CABG between July 2015 and May 2025 were included. Diagnosis of DD was based on diaphragm elevation on routine postoperative chest X-ray and confirmation via ultrasound (Sniff test). Postoperative outcomes were compared between patients with and without DD using inverse probability of treatment weighting (IPTW). Patients were followed with diaphragm imaging at 3-month intervals until recovery or 2 years.
Results: The incidence of postoperative DD after CABG was 3.1% (111/3594), with 60 left sided DD, 50 right sided DD, and 1 patient with bilateral DD. Preoperative characteristics were similar between those with and without DD, however, patients with DD had higher rate of chronic lung disease (31.5% [35/111] vs 19.9% [692/3483], p=0.004) and more bilateral IMA utilization (48.6% [54/111] vs 38.4% [1339/3483], p=0.04). Among patients who underwent left IMA harvest (including BIMA), the incidence of left sided DD was 1.7% (60/3477) and for isolated left IMA harvest, right sided DD incidence was 0.3% (7/2084). Among patients undergoing right IMA harvest (including BIMA), the incidence of isolated R DD was 2.9% (43/1469). After IPTW weighting, patients with DD had longer length of stay (10.7 ± 9.4 vs 8.7 ± 8.1 days; p=0.03), increased rates of postoperative pneumonias (5.7% vs 2.3%, p=0.02), reintubation (7.4% vs 2.1%, p=0.001), ICU readmission (5.0% vs 1.9%, p=0.04), and postoperative cardiac arrest (3.8% vs 1.1%, p=0.03). Early mortality was similar between groups (p=0.52). Among patients with DD, 79.3% (88/111) had follow up diaphragm imaging beyond 60 days from surgery. Of patients with left DD, 45% (27/60) demonstrated recovery after a median of 7.5 months (IQR 3.1-18.9), while 38% (19/50) of patients with right DD demonstrated recovery after a median of 3.6 months (IQR 3.1-33). Median follow-up time for patients without recovery was 13.0 months (IQR 4.1-44.4).
Conclusions: While the overall rate of diaphragm dysfunction after CABG surgery is low, it is associated with increased postoperative morbidity. IMA harvest is a risk factor for DD, however the laterality of harvest is not the only factor involved, and further investigation into other causes of diaphragm dysfunction after CABG is necessary.
Methods: Patients at a single institution who underwent CABG between July 2015 and May 2025 were included. Diagnosis of DD was based on diaphragm elevation on routine postoperative chest X-ray and confirmation via ultrasound (Sniff test). Postoperative outcomes were compared between patients with and without DD using inverse probability of treatment weighting (IPTW). Patients were followed with diaphragm imaging at 3-month intervals until recovery or 2 years.
Results: The incidence of postoperative DD after CABG was 3.1% (111/3594), with 60 left sided DD, 50 right sided DD, and 1 patient with bilateral DD. Preoperative characteristics were similar between those with and without DD, however, patients with DD had higher rate of chronic lung disease (31.5% [35/111] vs 19.9% [692/3483], p=0.004) and more bilateral IMA utilization (48.6% [54/111] vs 38.4% [1339/3483], p=0.04). Among patients who underwent left IMA harvest (including BIMA), the incidence of left sided DD was 1.7% (60/3477) and for isolated left IMA harvest, right sided DD incidence was 0.3% (7/2084). Among patients undergoing right IMA harvest (including BIMA), the incidence of isolated R DD was 2.9% (43/1469). After IPTW weighting, patients with DD had longer length of stay (10.7 ± 9.4 vs 8.7 ± 8.1 days; p=0.03), increased rates of postoperative pneumonias (5.7% vs 2.3%, p=0.02), reintubation (7.4% vs 2.1%, p=0.001), ICU readmission (5.0% vs 1.9%, p=0.04), and postoperative cardiac arrest (3.8% vs 1.1%, p=0.03). Early mortality was similar between groups (p=0.52). Among patients with DD, 79.3% (88/111) had follow up diaphragm imaging beyond 60 days from surgery. Of patients with left DD, 45% (27/60) demonstrated recovery after a median of 7.5 months (IQR 3.1-18.9), while 38% (19/50) of patients with right DD demonstrated recovery after a median of 3.6 months (IQR 3.1-33). Median follow-up time for patients without recovery was 13.0 months (IQR 4.1-44.4).
Conclusions: While the overall rate of diaphragm dysfunction after CABG surgery is low, it is associated with increased postoperative morbidity. IMA harvest is a risk factor for DD, however the laterality of harvest is not the only factor involved, and further investigation into other causes of diaphragm dysfunction after CABG is necessary.
ADULT CARDIAC:
Coronary Artery Disease
Image or Table
