Chest
Volume 116, Issue 6, December 1999, Pages 1608-1615
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Clinical Investigations
Lung Volume Reduction Surgery
Lung Function 4 Years After Lung Volume Reduction Surgery for Emphysema

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Study objectives

Current data for patients > 2 years after lung volume reduction surgery (LVRS) for emphysema is limited. This prospective study evaluates pre-LVRS baseline data and provides long-term results in 26 patients.

Intervention

Bilateral targeted upper lobe stapled LVRS using video thoracoscopy was performed in 26 symptomatic patients (18 men) aged 67 ± 6 years (mean ± SD) with severe and heterogenous distribution of emphysema on lung CT. Lung function studies were measured before and up to 4 years after LVRS unless death intervened.

Results

No patients were lost to follow-up. Baseline FEV1 was 0.7 ± 0.2 L, 29 ± 10% predicted; FVC, 2.1 ± 0.6 L, 58 ± 14% predicted (mean ± SD); maximum oxygen consumption, 5.7 ± 3.8 mL/min/kg (normal, > 18 mL/min/kg); dyspneic class ≥ 3 (able to walk ≤ 100 yards) and oxygen dependence part- or full-time in 18 patients. Following LVRS, mortality due to respiratory failure at 1, 2, 3, and 4 years was 4%, 19%, 31%, and 46%, respectively. At 1, 2, 3, and 4 years after LVRS, an increase above baseline for FEV1 > 200 mL and/or FVC > 400 mL was noted in 73%, 46%, 35%, and 27% of patients, respectively; a decrease in dyspnea grade ≥ 1 in 88%, 69%, 46%, and 27% of patients, respectively; and elimination of oxygen dependence in 78%, 50%, 33%, and 22% of patients, respectively. The mechanism for expiratory airflow improvement was accounted for by the increase in both lung elastic recoil and small airway intraluminal caliber and reduction in hyperinflation. Only FVC and vital capacity (VC) of all preoperative lung function studies could identify the 9 patients with significant physiologic improvement at > 3 years after LVRS, respectively, from 10 patients who responded ≤ 2 years and died within 4 years (p < 0.01).

Conclusions

Bilateral LVRS provides clinical and physiologic improvement for > 3 years in 9 of 26 patients with emphysema primarily due to both increased lung elastic recoil and small airway caliber and decreased hyperinflation. The 9 patients had VC and FVC greater at baseline (p < 0.01) when compared to 10 short-term responders who died < 4 years after LVRS.

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,

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  • 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.

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