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J Thorac Cardiovasc Surg 2003;125:513-525
© 2003 The American Association for Thoracic Surgery
General Thoracic Surgery |
From Washington University School of Medicine, Division of Cardiothoracic Surgery, Department of Surgery,a Division of Pulmonary Medicine and Critical Care, Department of Internal Medicine,b and Jacqueline Maritz Lung Center at Barnes-Jewish Hospital, St Louis, Mo.
Read at the Eighty-second Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-8, 2002.
Received for publication July 10, 2002. Revisions requested Aug 14, 2002; revisions received Sept 10, 2002. Accepted for publication Oct 1, 2002. Address for reprints: Joel D. Cooper, MD, One Barnes-Jewish Plaza, 3108 Queeny Tower, St Louis, MO 63110 (E-mail: cooperjo{at}msnotes.wustl.edu).
Objective: Numerous reports have confirmed the early benefits of lung volume reduction surgery for selected patients with emphysema. This report documents the long-term survival and functional results after lung volume reduction surgery.
Methods: Between January 1993 and June 2000, a total of 250 consecutive patients underwent bilateral lung volume reduction surgery through median sternotomy at our institution. All patients had disabling dyspnea, thoracic hyperinflation, and a heterogeneous pattern of emphysema with suitable target areas for resection. Preoperative pulmonary rehabilitation was required and post-rehabilitation data were used as the baseline for data analysis. Follow-up ranged from 1.8 to 9.1 years (median 4.4 years).
Results: Prolonged air leaks (>7 days) were the most common complication (45.2%, n = 113). Reexploration rates for air leak and bleeding were 3.2% (n = 8) and 1.2% (n = 3), respectively. Eighteen patients (7.2%) required reintubation and mechanical ventilation. The in-hospital mortality in this series was 4.8% (n = 12). The median length of hospitalization was 9 days (range 4-168 days). Kaplan-Meier survivals after lung volume reduction surgery were 93.6%, 84.4%, and 67.7% at 1, 3, and 5 years, respectively. Eighteen patients (7.2%) have subsequently undergone lung transplantation after a median interval of 4.3 years (range 2.1-6.4 years). Spirometric values, lung volumes, and gas exchange parameters improved after surgery. The forced expiratory volume in 1 second and the residual volume showed statistically significant improvements between preoperative values and each time point of follow-up. Health-related quality of life showed significant postoperative improvement and with time correlated well with the improvement in forced expiratory volume in 1 second.
Conclusions: Lung volume reduction surgery produces significant functional improvement for selected patients with emphysema. For most of these patients, benefits appear to last at least 5 years.
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J. Thorac. Cardiovasc. Surg. 2003 125: 457-459.
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