Lung volume reduction surgery combined with cardiac interventions

Objective: Postoperative course and functional outcome were evaluated in pa tients who underwent lung volume reduction surgery (LVRS) or in combination with valve replacement (VR), percutaneous transluminal coronary angioplast y (PTCA), placement of a stent, or coronary artery bypass grafting (CABG). Methods: Patients with severe bronchial obstruction and hyperinflation due to pulmonary emphysema were evaluated for lung volume reduction surgery. Ca rdiac disorders were screened by history and physical examination and asses sed by coronary angiography, Nine patients were accepted for LVRS in combin ation with an intervention for coronary artery disease (CAD). In addition, three patients with valve disease and severe emphysema were accepted for va lve replacement (two aortic-, one mitral. valve) only in combination with L VRS. Functional results over the first 6 months were analysed. Results: Pul monary function testing demonstrates a significant improvement in postopera tive FEV1 in patients who underwent LVRS combined with an intervention for CAD. This was reflected in reduction of overinflation (residual volume/tota l lung capacity (RV/TLC)), and improvement in the 12-min walking distance a nd dyspnea. Median hospital stay was 15 days (10-33). One patient in the CA D group died due to pulmonary edema on day 2 postoperatively. One of the th ree patients who underwent valve replacement and LVRS died on day 14 postop eratively following intestinal infarction. Both survivors improved in pulmo nary function, dyspnea score and exercise capacity. Complications in all 12 patients included pneumothorax (n = 2), hematothorax (n = 1) and urosepsis (n = 1). Conclusion: Functional improvement after LVRS in patients with CA D is equal to patients without CAD. Mortality in patients who underwent LVR S after PTCA or CABG was comparable to patients without CAD. LVRS enables v alve replacement in selected patients with severe emphysema otherwise inope rable, (C) 1999 Elsevier Science Ireland Ltd. AU rights reserved.