We prospectively analyzed 19 patients submitted to
lung volume reduction surgery (LVRS). Mean age 54 years. Fourteen patients, with predominant
emphysema of upper lobes, were approached through a
median sternotomy. Five patients with predominant lower lobes lesions, were approached through a bilateral anterolateral
thoracotomy. Surgery consisted in resection of 20 to 30% of lung volume corresponding to areas of severe parenchymal destruction by stapling
suture additioned with bovine pericardium. Changes in lung function and physical performance were evaluated by FEV1, FVC and RV, 6 minutes walk test and
dyspnea index according to Medical Research Council at 3, 12, 24, 36 and 48 months. Variance analysis with correction of Bonferroni was performed. One patient died of acute
myocardial infarction. There was a significant average improvement in all parameters measured at 3, 12, 24 and 36 months with regard to preoperative values. Comparing the preoperative and 3 months values, there was an increment in FEV1 from 0.94 +/- 0.37 (31% of predicted) to 1.35 +/- 0.40 L (45%) (p < 0.05), in FVC from 2.24 +/- 0.69 (54%) to 3.05 +/- 0.80 L (75%) (p < 0.05) and in 6 minutes walk test from 395 +/- 66 to 517 +/- 50 mts (p < 0.001). There was also a decrease in the RV of 4.78 +/- 1.14 L (284%) to 3 +/- 0.68 L (180%) (p < 0.001) and in
dyspnea index of 3.34 +/- 0.82 to 0.53 +/- 0.53 (p < 0.001). The percentage of average increment in FEV1 was 53% at 3 months (n = 18), 72% at 12 months (n = 13), 58% at 24 months (n = 10), 53% at 36 months (n = 6) and 60% at 48 months (n = 3). LVRS can be performed with acceptable morbidity and mortality in highly selected emphysematous patients. Decrease of
dyspnea and improvement in physical performance reach a maximum between 3 and 12 months and may remain so after four years.