Related Experiment Videos
Extended indications for lung volume reduction surgery in advanced emphysema
M Argenziano1, N Moazami, B Thomashow
1Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA.
The Annals of Thoracic Surgery
|December 1, 1996
Summary
Lung volume reduction surgery offers benefits for severe emphysema patients, even those with high-risk factors like hypercapnia or severe dysfunction. These conditions should not prevent patients from receiving this palliative therapy.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Respiratory Disease Research
Background:
- Lung volume reduction surgery (LVRS) is a palliative therapy for severe emphysema.
- Candidate selection traditionally relies on specific functional and anatomic criteria.
- Potential operative contraindications have been previously proposed.
Purpose of the Study:
- To evaluate the efficacy and safety of LVRS in severe emphysema patients, including those with high-risk factors.
- To determine if severe hypercapnia, steroid dependence, profound pulmonary dysfunction, or inability to complete rehabilitation are absolute contraindications for LVRS.
Main Methods:
- LVRS was performed on 85 severe emphysema patients over 15 months.
- Patient selection was based on severe hyperinflation, air trapping, diaphragmatic dysfunction, and disease heterogeneity.
- High-risk patients (severe hypercapnia, steroid dependence, etc.) were included and not excluded.
Main Results:
- Significant improvements observed in pulmonary function, exercise capacity, and dyspnea.
- Acceptable 30-day perioperative mortality of 7% and 6/12-month survival rates of 90%/83%.
- High-risk patients showed equivalent or superior outcomes compared to low-risk patients.
Conclusions:
- Severe hypercapnia, steroid dependence, profound pulmonary dysfunction, and inability to complete rehabilitation do not preclude successful LVRS.
- These factors should not be considered absolute exclusionary criteria for LVRS.
- LVRS can be safely and effectively performed in a broader range of severe emphysema patients.