Lung function 5 yr after lung volume reduction surgery for emphysema.

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 (FEV(1)) 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 FEV(1) > 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 FEV(1) 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 FEV(1) 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.

[1]  T. Mineo,et al.  Reduction pneumoplasty versus respiratory rehabilitation in severe emphysema: a randomized study. Pulmonary Emphysema Research Group. , 2000, The Annals of thoracic surgery.

[2]  D. Hansell,et al.  Effect of lung-volume-reduction surgery in patients with severe emphysema. , 2000, The New England journal of medicine.

[3]  J. Concato,et al.  Randomized, controlled trials, observational studies, and the hierarchy of research designs. , 2000, The New England journal of medicine.

[4]  G. Lowdermilk,et al.  Comparison of clinical results for unilateral and bilateral thoracoscopic lung volume reduction. , 2000, The Annals of thoracic surgery.

[5]  G. Criner,et al.  Prospective randomized trial comparing bilateral lung volume reduction surgery to pulmonary rehabilitation in severe chronic obstructive pulmonary disease. , 1999, American journal of respiratory and critical care medicine.

[6]  N. Zamel,et al.  Lung function 4 years after lung volume reduction surgery for emphysema. , 1999, Chest.

[7]  J. Bavaria,et al.  Long-term survival after thoracoscopic lung volume reduction: a multiinstitutional review. , 1999, The Annals of thoracic surgery.

[8]  B. Rubin,et al.  Outpatient Treatment of Deep Venous Thrombosis , 1999 .

[9]  E. Russi,et al.  Two years' outcome of lung volume reduction surgery in different morphologic emphysema types. , 1999, The Annals of thoracic surgery.

[10]  G. Patterson,et al.  Outcome of Medicare patients with emphysema selected for, but denied, a lung volume reduction operation. , 1998, The Annals of thoracic surgery.

[11]  G. Criner,et al.  Effect of lung volume reduction surgery on diaphragm strength. , 1998, American journal of respiratory and critical care medicine.

[12]  A. Wilson,et al.  Rate of FEV1 change following lung volume reduction surgery. , 1998, Chest.

[13]  M J Tobin,et al.  Effect of lung volume reduction surgery on neuromechanical coupling of the diaphragm. , 1998, American journal of respiratory and critical care medicine.

[14]  F. Martinez,et al.  Lung-volume reduction improves dyspnea, dynamic hyperinflation, and respiratory muscle function. , 1997, American journal of respiratory and critical care medicine.

[15]  E. Russi,et al.  Lung volume reduction surgery for emphysema. , 1997, The European respiratory journal.

[16]  D. Wood,et al.  Changes in breathing and ventilatory muscle recruitment patterns induced by lung volume reduction surgery. , 1997, American journal of respiratory and critical care medicine.

[17]  J. Sznajder,et al.  [Lung volume reduction surgery in patients with emphysema]. , 1997, Archivos de bronconeumologia.

[18]  N. Zamel,et al.  Mechanism of short-term improvement in lung function after emphysema resection. , 1996, American journal of respiratory and critical care medicine.

[19]  D. O’Donnell,et al.  Mechanisms of relief of exertional breathlessness following unilateral bullectomy and lung volume reduction surgery in emphysema. , 1996, Chest.

[20]  W. Knaus,et al.  Hospital and 1-Year Survival of Patients Admitted to Intensive Care Units With Acute Exacerbation of Chronic Obstructive Pulmonary Disease , 1995 .

[21]  N. Anthonisen.  Lung Health Study. , 1989, The American review of respiratory disease.

[22]  N. Anthonisen.  Prognosis in chronic obstructive pulmonary disease: results from multicenter clinical trials. , 1989, The American review of respiratory disease.

[23]  B. Burrows,et al.  Course and prognosis of chronic obstructive lung disease. A prospective study of 200 patients. , 1969, The New England journal of medicine.