title: Preoperative parameters and their prognostic value in amyotrophic lateral sclerosis patients undergoing implantation of a diaphragm pacing stimulation system.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with devastating and fatal respiratory complications. Diaphragm pacing stimulation (DPS) is a treatment option in diaphragm insufficient ALS patients. Ventilatory insufficiency depending on diaphragmatic failure is treated by the present study aimed to investigate prognostic value of preoperative clinical and functional characteristics of ALS patients undergoing implantation of a DPS system and to determine appropriate indications for the DPS system.
  
  
  METHODS
  The study included 34 ALS patients implanted with DPS system. All patients underwent multidisciplinary and laboratory evaluations before the surgery. The laboratory examinations included pulmonary function tests and arterial blood gas analysis. Survival rates were recorded in a 2-year follow-up after the surgery.
  
  
  RESULTS
  Twenty-eight of 34 patients with ALS survived after a 2-year follow-up. These patients were younger than those who died and had the disease for a longer time; however, the differences were not significant. Both right and left hemidiaghragms were thicker in the survived patients (P< 0.0001 for each). Pulmonary function tests revealed no significant differences between the patients who survived. Arterial blood gas analysis demonstrated lower partial pressure of carbon dioxide in the survived patients (P= 0.025).
  
  
  CONCLUSIONS
  DPS implantation was more efficacious in ALS patients with mild respiratory failure and thicker diaphragm. Predictors of long-term effectiveness of DPS system are needed to be addressed by large-scale studies.
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Aydın
authors.initials: A
authors.lastname: Şanlı
authors.affiliation: Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Ihsan Şükrü
authors.initials: IŞ
authors.lastname: Şengün
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Karaçam
authors.affiliation: Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Aylin Özgen
authors.initials: AÖ
authors.lastname: Alpaydın
authors.affiliation: Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Kemal Can
authors.initials: KC
authors.lastname: Tertemiz
authors.affiliation: Department of Physiotherapy and Rehabilitation, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Sevgi
authors.initials: S
authors.lastname: Özalevli
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Bahar Ağaoğlu
authors.initials: BA
authors.lastname: Şanlı
authors.affiliation: Turkish ALS-MNH Association, Izmir, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Kaya
authors.affiliation: Department of Thoracic Surgery, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Nezih
authors.initials: N
authors.lastname: Özdemir
keywords: Amyotrophic lateral sclerosis; diaphragm pacing; respiratory failure