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Abstract OBJECTIVE: In a prospective study, we investigated the functionalresults, complications and survival of bilateral video-assistedthoracoscopic (VAT) lung volume reduction (LVR) in a selected group ofpatients with severe, nonbullous pulmonary emphysema. From January 1994 toSeptember 1996, 42 of 143 candidates (13 female, 29 male, 42-78 years) wereoperated. They were short of breath on minimal exertion due to severeairflow obstruction and hyperinflation (FEV1 < 30%) pred., TLC > 130%pred., RV > 200% pred.). METHODS: LVR was performed bilaterally by VATusing endoscopic staplers without buttressing the staple lines. Pulmonaryfunction test (PFT), MRC dyspnea score and 12 min walking distance wereassessed preoperatively, at 3, 6 and 12 months. In addition lung functionwas measured at hospital discharge. RESULTS: The patients reported a markedrelief 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 atleast 1 year. The residual volume to total lung capacity ratio decreasedfrom 0.64 to 0.56 at hospital discharge. The mean 12 min walking distanceincreased 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), drainagetime was 9 +/- 4.3 (median 8.0) days. There was no 30 day mortality. Threepatients died between 2 and 15 months postoperatively by non surgeryrelated reasons. One patient underwent lung transplantation 5 months aftersurgical lung volume reduction. CONCLUSIONS: In a selected group ofpatients with severe, nonbullous pulmonary emphysema, bilateral LVR by VATresults in instantaneous postoperative improvement in pulmonary functionand dyspnea. These favorable effects, including an amelioriation inexercise performance, lasted for at least 1 year. This content is only available as a PDF. © 1997 Elsevier Science B.V.
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Jun 1, 1997
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