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Lung volume reduction surgery for severe emphysema.

AbstractBACKGROUND:
We report mid-term results after 25 consecutive lung volume reduction operations (LVRS) for the treatment of severe dyspnea due to advanced emphysema.
METHODS:
STUDY DESIGN:
patients were studied prospectively up to 12 months after surgery.
SETTING:
preoperative evaluation, surgery and postoperative care took place in our university hospital.
PATIENTS:
patient selection was based on severe dyspnea and airway obstruction despite optimal medical treatment, lung overinflation and completed rehabilitation programme. PATIENTS with severe hypercarbia (PCO2>50 mmHg) were excluded. Nineteen rehabilitated patients who fulfilled our inclusion criteria but postponed or denied LVRS were followed up clinically.
INTERVENTIONS:
LVRS was performed bilaterally in 22 patients (median sternotomy) and unilaterally in 3 patients (limited thoracotomy).
MEASURES:
Outcome was measured by dyspnea evaluation, 6-minute-walking distance and pulmonary function tests.
RESULTS:
Twelve months postoperatively dyspnea and mobility improved significantly (MRC score from 3.3+/-0.7 to 2.12+/-0.8, 6-min-walk from 251+/-190 to 477+/-189 m). These results were superior compared to the results of the conservatively treated patients. Significant improvement could also be documented in airway obstruction (FEV1 from 960+/-369 to 1438+/-610 ml) and overinflation (TLC from 133+/-14 to 118+/-21% predicted and RV from 280+/-56 to 186+/-59% predicted).
CONCLUSIONS:
LVRS is an effective and promising treatment option for selected patients with end-stage emphysema and could be offered as an alternative and / or bridge to lung transplantation.
AuthorsS Demertzis, H Wilkens, M Lindenmeir, T Graeter, H J Schäfers
JournalThe Journal of cardiovascular surgery (J Cardiovasc Surg (Torino)) Vol. 39 Issue 6 Pg. 843-7 (Dec 1998) ISSN: 0021-9509 [Print] Italy
PMID9972913 (Publication Type: Comparative Study, Journal Article)
Topics
  • Dyspnea (etiology, physiopathology, surgery)
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pneumonectomy (methods)
  • Prospective Studies
  • Pulmonary Emphysema (complications, physiopathology, surgery)
  • Respiratory Function Tests
  • Treatment Outcome

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