Departments: Interventional Pulmonology in Other Journals
Long-Term Outcome of Bilateral Lung Volume Reduction in 250 Consecutive Patients with Emphysema
J Thorac Cardiovasc Surg. 2003;125:513–525. Ciccone AM, Meyers BF, Guthrie TJ, Davis GE, Yusen RD, Lefrak SS, Patterson GA, Cooper JD. Washington University School of Medicine, Division of Cardiothoracic LVRS, Department of LVRS, St. Louis, MO.
This report documents the survival and functional results measured 1.8 to 9.1 years (median, 4.4 y) after bilateral lung volume reduction surgery (LVRS) in 250 consecutive patients who underwent this procedure. All patients had disabling dyspnea, thoracic hyperinflation, and a heterogeneous pattern of emphysema with suitable target areas for resection. The pre- and post-LVRS pulmonary rehabilitation data were used for analysis. The mean age of the patients was 62 ± 8 years. All patients were former smokers, and 50% were female. Most patients (n = 229) were seen with the major focus of disease in the upper lobes; however, the most severe destruction was in the lower lobes in 21 patients (8.4%), including 12 patients (4.8%) with known alpha1-antitrypsin deficiency. All but one procedure was performed through a median sternotomy. Prolonged air leaks (>7 days) were the most common complication (45%, n = 113). Reexploration rates for air leak and bleeding were 3% (n = 8) and 1% (n = 3), respectively. Eighteen patients (7%) required reintubation and mechanical ventilation. The in-hospital mortality in this series was 5% (n = 12). The median length of hospitalization was 9 days (range, 4–168 days). Kaplan-Meier survivals after lung volume reduction LVRS were 94%, 84%, and 68% at 1, 3, and 5 years, respectively. Eighteen patients (7%) subsequently underwent lung transplantation after a median interval of 4.3 years (range, 2.1–6.4 y). Spirometric values, lung volumes, and gas exchange parameters improved after LVRS. The FEV1 and the residual volume showed statistically significant improvements between preoperative values and each follow up. Health-related quality of life showed significant postoperative improvement and, with time, correlated well with the improvement in FEV1. The 90-day and complete in-hospital mortalities in this series were 4% (n = 10) and 4.8% (n = 12), respectively. All early postoperative deaths were attributed to respiratory failure, except one that was attributed to pulmonary embolism. There were no intraoperative deaths. The authors conclude that LVRS produces significant functional improvement for selected patients with emphysema, and for most of these patients, benefits appear to last at least 5 years. This study excluded patients with a homogeneous pattern of emphysematous destruction and did not address the issue of whether homogeneous destruction is an absolute or relative contraindication to LVRS.