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Am. J. Respir. Crit. Care Med., Volume 163, Number 7, June 2001, 1562-1566

Lung Function 5 yr after Lung Volume Reduction Surgery for Emphysema

ARTHUR F. GELB, ROBERT J. McKENNA Jr., MATTHEW BRENNER, JOEL D. EPSTEIN, and NOE ZAMEL

Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, University of California, Los Angeles, California; School of Medicine, University of California, Irvine, California; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Thoracic Surgery, Chapman Medical Center, Orange, California; and Cedars-Sinai Medical Center and University of California, Los Angeles, California

Current datum more than 2 yr after lung volume reduction surgery (LVRS) for emphysema is limited. This prospective study evaluates pre-LVRS baseline and 5-yr results in 26 symptomatic patients (mean age 67 ± 6 yr) (mean ± SD) who underwent bilateral, targeted upper lobe stapled LVRS using video-assisted thoracoscopy. Baseline forced expiratory volume in 1 s (FEV1) was 0.7 ± 0.2 L (mean ± SD), 29 ± 10% predicted. Following LVRS, with none lost to follow-up, mortality due to respiratory failure at 0.5, 1, 2, 3, 4, and 5 yr was 4%, 4%, 19%, 31%, 46%, and 58%, respectively. Increase above baseline for FEV1 > 200 ml and/or FVC > 400 ml at 1, 2, 3, 4, and 5 yr post-LVRS was noted in 73%, 46%, 35%, 27%, and 8% of all patients; decrease in dyspnea grade >=  1 in 88%, 69%, 46%, 27%, and 15%; and elimination of initial oxygen dependence in 18 patients in 78%, 50%, 33%, 22%, and 0%, respectively. Expiratory airflow improved due to the increase in both lung elastic recoil and small airway intraluminal caliber. Five patients decreased FEV1 141 ± 60 ml/yr and FVC 102 ± 189 ml/yr over 3.8 ± 1.2 yr post-LVRS, similar to their pre-LVRS rate of decline. In the 11 patients who survived 5 yr, at 0.5-1.0 yr post-LVRS peak increase in FEV1 was 438 ± 366 ml, with a decline of 149 ± 157 ml the following year and 78 ± 59 ml/yr over 4.0-4.5 yr. Bilateral LVRS provided palliative clinical and physiological improvement in 9 of 26 patients at 3 yr, 7 at 4 yr, and 2 at 5 yr.




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