Lung function 4 years after lung volume reduction surgery for emphysema

Study objectives: Current data for patients > 2 years after lung volume red uction surgery (LVRS) for emphysema is limited. This prospective study eval uates pre-LVRS baseline data and pro rides long-term results in 26 patients . Intervention: Bilateral targeted upper lobe stapled LVRS using video thorac oscopy was performed in 26 symptomatic patients (18 men) aged 67 +/- 6 year s (mean +/- SD) with severe and heterogenous distribution of emphysema on l ung CT. Lung function studies were measured before and up to 4 years after LVRS unless death intervened. Results: So patients were lost to follow-up. Baseline FEV1 was 0.7 +/- 0.2 L, 29 +/- 10% predicted; FVC, 2.1 +/- 0.6 L, 58 +/- 14% predicted (mean +/- SD); maximum oxygen consumption, 5.7 +/- 3.8 mL/min/kg (normal, > 18 mL/mi n/kg); dyspneic class greater than or equal to 3 (able to walk less than or equal to 100 yards) and oxygen dependence part- or full-time in Is patient s. Following LVRS, mortality due to respiratory failure at 1, 2, 3, and 4 y ears was 4%, 19%, 31%, and 46%, respectively. At 1, 2, 3, and 4 years 5 aft er LVRS, an increase above baseline for FEV1 > 200 mL and/or FVC > 400 mL w as noted in 73%, 46%, 35%, and 27% of patients, respectively; a decrease in dyspnea grade greater than or equal to 1 in 88%, 69%, 46%, and 27% of pati ents, respectively, and elimination of oxygen dependence in 78%, 50%, 33%, and 22% of patients, respectively. The mechanism for expiratory airflow imp rovement was accounted for by the increase in both lung elastic recoil and small airway intraluminal caliber and reduction in hyperinflation. Only FVC and vital capacity (VC) of all preoperative lung function studies could id entify the 9 patients with significant physiologic improvement at > 3 years after LVRS, respectively, from 10 patients who responded less than or equa l to 2 years and died within 4 years (p < 0.01), Conclusions: Bilateral LVRS provides clinical and physiologic improvement f or > 3 years in 9 of 26 patients with emphysema primarily due to both incre ased lung elastic recoil and small airway caliber and decreased hyperinflat ion. The 9 patients had VC and FVC gl eater at baseline (p < 0.01) when com pared to 10 short-term responders who died < 4 years after LVRS.