Context:

The implantation of commercially available phrenic nerve/diaphragm pacers has been available for more than 40 years and has enabled thousands of patients in over 40 countries to achieve freedom from invasive mechanical ventilation.

Objective:

The cervical approach to implantation of these pacers is described, as are the pros and cons of using this technique compared to intrathoracic and sub-diaphragmatic.

Methods:

Study design was a retrospective review of 1,522 subjects from the Avery Biomedical Devices (ABD) database who were implanted with the Avery diaphragm pacer. Long term statistics from patients implanted with diaphragm pacers are presented as well.

Results:

17% of cervically placed electrodes required at least one replacement compared to 18% of electrodes placed thoracically. Devices implanted cervically show no significant difference in their longevity than those implanted using the thoracic approach (P value of 0.9382 using Two-Sample t-Test). The mean longevity for both approaches was found to be 6.4 years. The majority of electrodes implanted have never required replacement. A majority of CCHS patients were implanted using the thoracic approach and only find it necessary to use the device during sleeping hours. Most of the cervically implanted patients are found to be older at the time of implantation and implanted for diagnoses that require longer daily use of the device.

Conclusion:

The cervical approach for the implantation of phrenic nerve/diaphragm pacers is the most minimally invasive, but underutilized, technique that allows for the use of local or monitored anesthesia, does not require entering any body cavities, and keeps incision size small.

中文翻译：

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使用微创颈椎方法进行隔膜起搏

语境：

市售的膈神经/膈肌起搏器植入技术已有 40 多年的历史，已使 40 多个国家/地区的数千名患者摆脱了有创机械通气。

客观的：

介绍了植入这些起搏器的颈椎入路，以及与胸腔内和膈下植入相比使用该技术的优缺点。

方法：

研究设计是对 Avery Biomedical Devices (ABD) 数据库中植入 Avery 隔膜起搏器的 1,522 名受试者的回顾性研究。还提供了植入隔膜起搏器的患者的长期统计数据。

结果：

17% 的颈部电极需要至少更换一次，而 18% 的胸部电极需要更换。颈部植入的装置与使用胸部方法植入的装置相比，其寿命没有显着差异（使用双样本 t 检验的 P 值为 0.9382）。发现这两种方法的平均寿命为 6.4 年。大多数植入的电极都不需要更换。大多数 CCHS 患者使用胸腔入路进行植入，并且只发现有必要在睡眠时间使用该设备。大多数宫颈植入患者被发现在植入时年龄较大，并且植入是为了需要更长时间每天使用该设备的诊断。

结论：

用于植入膈神经/隔膜起搏器的颈椎入路是微创技术，但未得到充分利用，该技术允许使用局部或监测麻醉，不需要进入任何体腔，并且切口尺寸较小。