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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES THORACIC PAPERS
The Journal of Cardiovascular Surgery 1998 Dicembre;39(6):843-7
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.