TY - JOUR
T1 - Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema
AU - Cooper, J. D.
AU - Patterson, G. A.
AU - Sundaresan, R. S.
AU - Trulock, E. P.
AU - Yusen, R. D.
AU - Pohl, M. S.
AU - Lefrak, S. S.
AU - Benfield, J. R.
AU - Vaughn, C. C.
N1 - Funding Information:
I close with a comment about the current lack of Medicare funding for lung volume reduction and with a question. The organizations that are the national forums for science and continuing education in thoracic surgery and in pulmonary medicine have advised HCFA that they do not consider lung volume reduction experimental. Hospital costs and professional fees therefore should be paid by Medicare when the procedure is offered to properly selected patients in centers that have track records successfully conducted, credible clinical research. There is no doubt that further research on the treatment of end-stage lung disease needs to be done and that lung volume reduction is a prime example for HCFA and the National Institutes of Health (NIH) to come together. HCFA should fund the patient care aspects of the treatment, and the NIH should support the needed research costs. Organized thoracic surgery spearheaded by the Society of Thoracic Surgeons and supported by the American Association for Thoracic Surgery and respiratory medicine have stepped forward and offered help to HCFA and the NIH in this regard. I hope that these agencies will accept this offer on behalf of patients whose dyspnea deserves palliation. I believe that a randomized study in the early 1970s to compare aortocoronary bypass to the then best available nonoperative treatment would have resulted in far quicker acceptance of the operation than occurred. We are at a similar stage with lung volume reduction, because it remains possible and perhaps likely that the benefits of lung volume reduction will prove to be transient.
PY - 1996
Y1 - 1996
N2 - Between January 1993 and February 1996, we performed 150 bilateral lung volume reduction procedures for patients with severe emphysema. Patients were selected on the basis of severe dyspnea, increased lung capacity, and a pattern of emphysema that included regions of severe destruction, hyperinflation, and poor perfusion. Twenty percent to 30% of the volume of each lung was excised with the use of a linear stapler and bovine pericardial strips attached to buttress the staple line. Patients were between 36 and 77 years old, with an average 1-second forced expiratory volume of 25% of predicted, total lung capacity of 142% of predicted, and residual volume of 283% of predicted. Ninety-three percent of patients required supplemental oxygen, continuously or with exertion. All patients but one were extubated at the end of the procedure. The 90-day mortality was 4%. Hospital stay progressively decreased with experience, and for the last 50 patients the median hospital stay was 7 days. Prolonged air leakage was the major complication. Results at 6 months show a 51% increase in the 1-second forced expiratory volume and a 28% reduction in the residual volume. The PaO2 increased by an average of 8 mm Hg, and 70% of the patients who had previously required continuous supplemental oxygen no longer had this requirement. The improvements in measured pulmonary function were paralleled by a significant reduction in dyspnea and an improvement in the quality of life. Reevaluation at 1 year and 2 years after operation showed the benefit to be well maintained. We conclude that lung volume reduction offers benefits not achievable by any means other than lung transplantation for highly selected patients with severe emphysema.
AB - Between January 1993 and February 1996, we performed 150 bilateral lung volume reduction procedures for patients with severe emphysema. Patients were selected on the basis of severe dyspnea, increased lung capacity, and a pattern of emphysema that included regions of severe destruction, hyperinflation, and poor perfusion. Twenty percent to 30% of the volume of each lung was excised with the use of a linear stapler and bovine pericardial strips attached to buttress the staple line. Patients were between 36 and 77 years old, with an average 1-second forced expiratory volume of 25% of predicted, total lung capacity of 142% of predicted, and residual volume of 283% of predicted. Ninety-three percent of patients required supplemental oxygen, continuously or with exertion. All patients but one were extubated at the end of the procedure. The 90-day mortality was 4%. Hospital stay progressively decreased with experience, and for the last 50 patients the median hospital stay was 7 days. Prolonged air leakage was the major complication. Results at 6 months show a 51% increase in the 1-second forced expiratory volume and a 28% reduction in the residual volume. The PaO2 increased by an average of 8 mm Hg, and 70% of the patients who had previously required continuous supplemental oxygen no longer had this requirement. The improvements in measured pulmonary function were paralleled by a significant reduction in dyspnea and an improvement in the quality of life. Reevaluation at 1 year and 2 years after operation showed the benefit to be well maintained. We conclude that lung volume reduction offers benefits not achievable by any means other than lung transplantation for highly selected patients with severe emphysema.
UR - http://www.scopus.com/inward/record.url?scp=0029803214&partnerID=8YFLogxK
U2 - 10.1016/S0022-5223(96)70147-2
DO - 10.1016/S0022-5223(96)70147-2
M3 - Article
C2 - 8911330
AN - SCOPUS:0029803214
SN - 0022-5223
VL - 112
SP - 1319
EP - 1330
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -