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European Journal of Cardio-Thoracic Surgery, Vol 11, 1005-1010, Copyright © 1997 by European Association for Cardio-thoracic Surgery
U Stammberger, R Thurnheer, KE Bloch, A Zollinger, RA Schmid, EW Russi and W Weder
OBJECTIVE: In a prospective study, we investigated the functional results,
complications and survival of bilateral video-assisted thoracoscopic (VAT)
lung volume reduction (LVR) in a selected group of patients with severe,
nonbullous pulmonary emphysema. From January 1994 to September 1996, 42 of
143 candidates (13 female, 29 male, 42-78 years) were operated. They were
short of breath on minimal exertion due to severe airflow obstruction and
hyperinflation (FEV1 < 30%) pred., TLC > 130% pred., RV > 200%
pred.). METHODS: LVR was performed bilaterally by VAT using endoscopic
staplers without buttressing the staple lines. Pulmonary function test
(PFT), MRC dyspnea score and 12 min walking distance were assessed
preoperatively, at 3, 6 and 12 months. In addition lung function was
measured at hospital discharge. RESULTS: The patients reported a marked
relief of dyspnea, which persisted at all follow-up visits (P<0.001).
FEV1 increased from 0.80 +/- 0.24 (L) to 1.14 +/- 0.41 (L) postoperatively,
a 43% gain (P < 0.001). A relevant increase of FEV1 persisted for at
least 1 year. The residual volume to total lung capacity ratio decreased
from 0.64 to 0.56 at hospital discharge. The mean 12 min walking distance
increased from 500 +/- 195 (m) to 770 +/- 222 (m) after 1 year (P <
0.001). The mean hospital stay was 13 +/- 5.5 days (median 12.0), drainage
time was 9 +/- 4.3 (median 8.0) days. There was no 30 day mortality. Three
patients died between 2 and 15 months postoperatively by non surgery
related reasons. One patient underwent lung transplantation 5 months after
surgical lung volume reduction. CONCLUSIONS: In a selected group of
patients with severe, nonbullous pulmonary emphysema, bilateral LVR by VAT
results in instantaneous postoperative improvement in pulmonary function
and dyspnea. These favorable effects, including an amelioriation in
exercise performance, lasted for at least 1 year.
ARTICLES
Thoracoscopic bilateral lung volume reduction for diffuse pulmonary emphysema
Department of Surgery, University Hospital, Zurich, Switzerland.
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