Surgical and functional results after surgical lung volume reduction in patients with severe emphysema

Lung volume reduction (LVR) is a new surgical approach designed to relieve shortness of breath and improve exercise tolerance in patients with severe lung emphysema. The aim of this study was to analyse surgical results and c hanges in the lung function, gas exchange, exercise tolerance and degree of dyspnoea until two years after LVR. From June 1994 to September 1997 ninet y-four patients (31 women and 63 men, mean age 64 [35-79] years) with sever e emphysema (12 with al-Pi-deficiency) underwent unilateral (n = 24) or bil ateral (n = 70) LVR. 92 from 94 patients were extubated immediately after s urgery. 30 days mortality was 2.2% (2/94), 90 days 3.3% (3/94) respectively . Most common postoperative complications were pneumonia (n = 15, 16%) and air leakage longer than 7 days (n = 22, 23.4%). One month after surgery the re was a significant increase in forced expiratory vital capacity after one second (FEV1 59%) and significant decrease in total lung capacity (TLC 19% ) and residual volume (RV 28%). Also significant changes were observed in p aO(2), paCO(2), 6-minute walking distance, dyspnoea score and respiratory m uscle function. Two years after LVR lung function tests in patients with sm okers emphysema showed the benefit to be maintained (high responders). Pati ents with alpha 1-Pi-deficiency showed 6 to 12 months after surgery a remar kable deterioration of functional data (low responders). In selected patien ts with severe emphysema surgical LVR shows significant improved pulmonary function, gas exchange, dyspnoea and walking distance. The results are bett er after bilateral operation. Patients selection. rehabilitation program an d interdisciplinary care resulted in a low operative morbidity and mortalit y.