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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1998 December;39(6):843-7

THORACIC PAPERS 

    ORIGINAL ARTICLES

Lung vol­ume reduc­tion sur­gery for ­severe emphy­se­ma

Demertzis S., Wilkens H., Lindenmeir M., Graeter T., Schafers H. J.

From the Department of Thoracic & Cardiovascular Surgery and the *Department of Pneumology University Hospital Homburg/Saar Saarland University, Homburg/Saar, Germany

Background. 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 full­filled 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.

language: English


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