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Original Articles: General Thoracic

Outcomes After Unilateral Lung Volume Reduction

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
^b Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
^c Division of Thoracic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania

Accepted for publication March 18, 2008.

^_* Address correspondence to Dr Meyers, Washington University School of Medicine, Department of Cardiothoracic Surgery, 3108 Queeny Tower, One Barnes-Jewish Hospital Plaza, St. Louis, MO 63110–1013 (Email: meyersb{at}wustl.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

Background: For patients with end-stage emphysema undergoing lung volume reduction surgery (LVRS), we have preferred a bilateral (BLVRS) approach to achieve maximum benefit with a single procedure. A unilateral (ULVRS) approach has been used in certain patients in whom BLVRS is contraindicated.

Methods: Between January 1993 and December 2006, 43 consecutive patients underwent ULVRS. The study excluded patients undergoing giant bullectomy. Relative contraindications for BLVRS were unilateral emphysema, 21; unilateral emphysema plus other factors, 2; and other factors alone, 10. Preoperative pulmonary rehabilitation was required. Postrehabilitation data were used as the baseline for analyses. Outcome measurements for ULVRS were compared with BLVRS results.

Results: After ULVRS, the mean increase in forced expiratory volume in 1 second (FEV₁) from postrehabilitation values was 32% at 6 months (p 0.001) and 28% at 3 years (p = 0.036). The FEV₁ was not significantly improved at 5 years. The mean reduction in residual volume after ULVRS was 23% at 6 months (p 0.001) and 38% at 5 years (p = 0.001). Supplemental oxygen requirements declined initially postoperatively. One patient (2%) died in the hospital. The 90-day mortality was 0%. Kaplan-Meier survival after ULVRS was 97.7%, 80.9%, and 45.5%, at 1, 3, and 5 years.

Conclusions: ULVRS produces improvements in pulmonary function, exercise capacity, and quality of life with an acceptable morbidity and mortality in patients for whom BLVRS is contraindicated, but the benefits are of lower magnitude than those achieved with BLVRS.

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