In June, thoracic surgeon Saeid Khansarinia, M.D., implanted a diaphragm pacing system using a minimally invasive thoracic surgery technique, as opposed to an abdominal procedure due to the patient’s specific needs. The modified surgical method will make it possible for Lynn Wheeler of Fayetteville, Ga., to breathe more naturally using an implanted diaphragm pacer instead of a ventilator.
Diaphragm pacing first gained national attention in 2003, when Raymond Onders, M.D., of University Hospitals Case Medical Center implanted a diaphragm pacing system in actor Christopher Reeve via an abdominal surgery. The device eventually enabled Reeve to breathe without the use of a ventilator.
Dr. Khansarinia is one of the latest additions to Piedmont Heart Institute Physicians as part of its expanding cardiothoracic surgery services. He is one of only 18 surgeons performing this procedure through the abdomen and the only surgeon who has performed this operation through the chest. Specializing in thoracic surgery, Dr. Khansarinia is a graduate of St. Louis University and completed his residency at the University of Florida Health Science Center. He is board certified in both general and thoracic surgery.
Functioning in a way similar to heart pacemakers, small electrodes are placed on the diaphragm where they stimulate the muscle to contract, pulling in air through the lungs. The patient carries a small external device that allows them more mobility than the larger machines and breathing tube necessary with a ventilator.
Wheeler, now 63 years old, was left paralyzed after a car accident five years ago and has required the assistance of a breathing tube. However, abdominal surgery was not an option for her. Unfortunately, due to multiple previous surgeries on her abdomen and the nature of her injuries, access to the diaphragm through the chest was the only option for this kind of procedure.
Determined to find a way to help his patient achieve a better quality of life, Dr. Khansarinia and his team in collaboration with Dr. Onders, developed a method to implant a diaphragm pacer through the chest.
As Wheeler’s diaphragm learns to contract and relax again over the next few months, she will be able to rest at home while the diaphragm pacing device works along with the ventilator. Eventually patients with diaphragm pacers are weaned off their ventilators as the diaphragm strengthens and breathing occurs more normally.
“Mrs. Wheeler is doing well. Currently she is off the ventilator and breathing with the pacer over four hours per day,” Dr. Khansarinia said. “She is very happy with her outcome and within a few months to a year, we hope she will be able to breathe without the need of a ventilator.”
For patients with quadriplegia, a diaphragm pacing system can mean a greatly improved quality of life. Communication becomes easier as speech is no longer hindered with the operation of a breathing tube. Sense of taste and smell will also improve for many patients. The risk of infection and pneumonia is significantly decreased for patients who are not dependent on a ventilator.
“What we’ve found is that the sooner we can approach patients with quadriplegia and implant the device, the quicker they recover to a more normal breathing state,” Dr. Khansarinia said. “With older patients and with patients that have been on a ventilator for a longer period of time, it will take a little longer for their diaphragm to relearn its original function with the assistance of a diaphragm pacing system.”
“This procedure has a lasting effect patients’ quality of life,” Dr. Khansirania said. “Their sense of smell and taste often return as air is no longer being forced into the lungs and can now flow freely through the nose and mouth. Most importantly, it gives them an improved sense of self and freedom as their speech pattern returns and they are able to communicate more naturally.”