Lung function after bilateral lower lobe lung volume reduction surgery foralpha(1)-antitrypsin emphysema

This study explores the mechanism(s) of airflow limitation following lung v olume reduction surgery (LVRS) in patients with emphysema due to homozygous alpha(1)-antitrypsin (AT) deficiency Bilateral targeted lower lobe stapled LVRS using video thoracoscopy was per formed in sig patients (five males) aged 61+/-9 yrs (mean+/-SD) with alpha( 1)-AT emphysema, Two patients received only a 6-month follow-up. However, four patients, at 22, 24, 27 and 36 months post-LVRS, noted relief from dyspnoea and increase d walk tolerance. At 27+/-6 months (mean+/-SD) post-LVRS, their forced expi ratory volume Tn one second improved only from 30+/-2% of the predicted val ue (mean+/-SEM!) before surgery to 33+/-1% pred after surgery. Yet, total l ung capacity (TLC) decreased from 151+/-13 to 127+/-10%, pred; diffusing ca pacity increased from 35+/-9 to 59+/-9% pred: and vital capacity increased from 68+/-10 to 88+/-5% pred, In three patients, static lung elastic recoil at TLC increased from 1.1+/-0.15 to 1.2+/-0.10 kPa, Using flow/pressure cu rves, the mechanism for expiratory airflow limitation pre-LVRS and the impr ovement noted post-LVRS could be primarily accounted for by the initial los s and subsequent increase in lung elastic recoil. Bilateral lung volume reduction surgery provides modest physiologic improve ment for 2-3 Is in patients with alpha(1)-antitrypsin emphysema due to incr eases in lung elastic recoil.