HEMODYNAMICS AND GAS-EXCHANGE AFTER SINGLE-LUNG TRANSPLANTATION AND UNILATERAL THORACOSCOPIC LUNG REDUCTION

Background: Single lung transplantation and recently thoracoscopic lun g reduction (TLR) have become surgical alternatives to manage emphysem a. We report here early outcomes of 10 single lung transplant (SLT) re cipients with severe emphysema compared with 10 patients treated with unilateral TLR. Methods: Ten consecutive recipients of (SLT) and 10 pa tients undergoing unilateral TLR were studied. Both groups had measure ments of preoperative pulmonary function and arterial blood gases. Hem odynamic measurements were made by use of a right ventricular ejection fraction/volumetric pulmonary artery catheter during and immediately after surgery in both groups to compare hemodynamic and gas exchange r esponse in each procedure. Pulmonary function tests were repeated 3 mo nths and 1 year after surgery. Complications and functional outcome ar e reported. Results: Both groups had the same severity of obstructive disease (mean forced expiratory volume in 1 second = 20% +/- 5% for th e SLT group and 23% +/- 9% for the TLR group) and similar patterns of right ventricular dysfunction. During operation, SLT recipients showed worse hypercapnia and pulmonary hypertension than TLR subjects when v entilation and perfusion to the operative lung were interrupted. Patie nts undergoing TLR only had interrupted ventilation, which was transie ntly reversed when severe hypoventilation or hypoxemia occurred. All p atients undergoing TLR were extubated immediately after surgery. SLT r ecipients were extubated an average of 42 hours later. Pulmonary funct ion testing performed 3 months after surgery showed improvement in bot h groups. SLT recipients showed larger improvements in airflow but com parable improvements in forced vital capacity. Both groups achieved si milar improvements in gas exchange. This trend continued a year after surgery. Patients undergoing TLR were not subjected to complications o f immunosuppressive therapy or exposed to opportunistic infections. Co nclusions: Early results show TLR as an acceptable alternative to SLT in carefully selected patients with the same severity of obstructive l ung disease. Long-term follow-up studies are needed to establish long- term differences in functional outcome and development of complication s. TLR may be an option for patients with severe dyspnea related to em physema who do not meet criteria for transplantation.