Chest
Clinical InvestigationsLung Volume Reduction SurgeryLung Function 4 Years After Lung Volume Reduction Surgery for Emphysema
Section snippets
Patient Selection
The emphysematous patients were markedly symptomatic with grade≥ 3 dyspnea10 (able to walk ≤ 100 yards), who had exhausted all medical therapy including antibiotics, aerosol and systemic bronchodilators (including β2-agonists and ipratropium bromide), aerosol and systemic corticosteroids, and repeated attempts at physical conditioning. As previously noted, high-resolution, thin-section CT of the lung demonstrated emphysema severity scores11 ≥ 60 with heterogenous distribution, ie, severe
Results
The results of preoperative lung function studies in the 26 patients (18 men) aged 67 ± 6 years (mean ± SD) are reported in Table 1. Preoperative spirometry, lung volumes, and Dlco in the 26 patients were not significantly (p > 0.05) different from the other 56 patients (data not shown) who underwent LVRS during the same study period, but were not studied in greater detail.5
Results in the 26 patients indicate at baseline very severe expiratory airflow limitation, hyperinflation at TLC,
Discussion
This prospective study, with no patients lost to follow-up, demonstrates that following bilateral LVRS for emphysema, durable clinical and significant physiologic improvement was achieved in 9 of 26 patients at 3 years, and in 7 of 26 patients at 4 years.
These observations, based on very strict outcome criteria, are impressive in elderly patients with end-stage emphysema with a high mortality rate from respiratory failure. Preoperatively, they had very severe airflow limitation, hyperinflation,
References (51)
- et al.
Serial lung function and elastic recoil 2 years after lung volume reduction surgery for emphysema
Chest
(1998) - et al.
Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema
J Thorac Cardiovasc Surg
(1996) - et al.
Lung volume reduction in patients with severe diffuse emphysema: a retrospective study
Chest
(1996) - et al.
Survival following bilateral stapled lung volume reduction surgery for emphysema
Chest
(1999) - et al.
Outcome of Medicare patients with emphysema selected for, but denied, a lung volume reduction operation
Ann Thorac Surg
(1998) - et al.
Contribution of emphysema and small airways in COPD
Chest
(1996) - et al.
Effect of aging on lung mechanics in healthy non-smokers
Chest
(1975) - et al.
Cardiopulmonary function after lobectomy or pneumonectomy for pulmonary neoplasm
Respir Med
(1989) - et al.
The effect of pulmonary resection on the compliance of human lungs
J Thorac Cardiovasc Surg
(1959) - et al.
Changes in pulmonary function after bullectomy
Am J Med
(1969)
Long-term results of surgery for bullous emphysema
J Thorac Cardiovasc Surg
Contribution of lung and chest wall mechanics following emphysema resection
Chest
Mechanisms of relief of exertional breathlessness following unilateral bullectomy and lung volume reduction surgery in emphysema
Chest
Two-year results after lung volume reduction surgery in α1-antitrypsin deficiency versus smoker's emphysema
Eur Respir J
Prognosis in chronic obstructive pulmonary disease: results from multicenter clinical trials
Am Rev Respir Dis
Course and prognosis of chronic obstructive lung disease: a prospective study of 200 patients
N Engl J Med
Hospital and 1 year survival of patients admitted in intensive care units with exacerbation of chronic obstructive pulmonary disease
JAMA
Official statement of the American Thoracic Society
Am Rev Respir Dis
Patient selection criteria for lung volume reduction surgery
J Thorac Cardiovasc Surg
Failure of body plethysmography in bronchial asthma
J Appl Physiol
Problems in plethysmographic assessment of changes of total lung capacity in asthma
Am Rev Respir Dis
Mechanism of short-term improvement in lung function following emphysema resection
Am J Respir Crit Care Med
Physiologic diagnosis of subclinical emphysema
Am Rev Respir Dis
Mechanisms of maximal expiratory flow limitation in clinically unsuspected emphysema and obstruction of the peripheral airways
Am Rev Respir Dis
Simplified diagnosis of small airway obstruction
N Engl J Med
Cited by (0)
Supported by Department of Energy Grant No. DE-FG03–91ER61227, American Lung Association Grant No. CI-030-N, and California Tobacco Related Disease Research Program Grant No. 6RT-0158.