title: Thoracoscopic placement of phrenic nerve pacers for diaphragm pacing in congenital central hypoventilation syndrome.
abstract: OBJECTIVE
  Congenital central hypoventilation syndrome (CCHS), or Ondine's curse, is a rare disorder affecting central respiratory drive. Patients with this disorder fail to ventilate adequately and require lifelong ventilatory support. Diaphragm pacing is a form of ventilatory support which can improve mobility and/or remove the tracheostomy from CCHS patients. Little is known about complications and long-term outcomes of this procedure.
  
  
  METHODS
  A single-center retrospective review was performed of CCHS patients undergoing placement of phrenic nerve electrodes for diaphragm pacing between 2000 and 2012. Data abstracted from the medical record included operation duration, ventilation method, number of trocars required, and postoperative and pacing outcomes.
  
  
  RESULTS
  Charts of eighteen patients were reviewed. Mean surgical time was 3.3±0.7 hours. In all cases except one, three trocars were utilized for each hemithorax, with no conversions to open procedures. Five patients (27.8%) experienced postoperative complications. The mean ICU stay was 4.3±0.5 days, and the mean hospital stay is 5.7±0.3days. Eleven patients (61.1%) achieved their daily goal pacing times within the follow-up period.
  
  
  CONCLUSIONS
  Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing is a safe and effective treatment modality for CCHS. Observed complications were temporary, and the majority of patients were able to achieve pacing goals.
authors.affiliation: University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Kristina J
authors.initials: KJ
authors.lastname: Nicholson
authors.affiliation: University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Nosanov
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Kanika A
authors.initials: KA
authors.lastname: Bowen
authors.affiliation: Department of Pulmonology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Sheila S
authors.initials: SS
authors.lastname: Kun
authors.affiliation: Department of Pulmonology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Iris A
authors.initials: IA
authors.lastname: Perez
authors.affiliation: Department of Pulmonology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Keens
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: cshin@chla.usc.edu.
authors.forename: Cathy E
authors.initials: CE
authors.lastname: Shin
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003964:Diaphragm / Q000294:innervation*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007040:Hypoventilation / Q000151:congenital* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D010791:Phrenic Nerve / Q000502:physiology*; D012189:Retrospective Studies; D020182:Sleep Apnea, Central / Q000628:therapy*; D013906:Thoracoscopy; D014139:Tracheostomy; D016896:Treatment Outcome
keywords: Congenital central hypoventilation syndrome; Diaphragmatic pacing; Ondine’s curse; Phrenic nerve electrodes