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Ann Thorac Surg 1999;67:1217-1218
© 1999 The Society of Thoracic Surgeons

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Correspondence

Bilateral anterior thoracotomies for lung volume reduction

^a Department of Cardiothoracic Surgery, The Alfred Hospital, Commercial Rd, Prahran, Victoria 3181 Australia

To the Editor

I write in response to the article by de Perrot and associates [1] and to the accompanying invited commentaries by Sundaresan and Klepetko published recently in The Annals of Thoracic Surgery concerning the use of muscle-sparing anterior thoracotomies for one-stage bilateral lung volume reduction (LVR). I have found this approach to be extremely useful in 2 patients who previously had a cardiac surgical procedure and in whom I sought to avoid a repeat sternotomy.

The first patient was a 58-year-old man who, 7 years previously, had triple coronary artery bypass grafting (left internal mammary artery to left anterior descending coronary artery, right internal mammary artery to posterior descending coronary artery and saphenous vein graft to diagonal branch of left anterior descending artery). Each pleural space was opened widely for the internal mammary artery harvests and was left open at the end of the procedure. Repeat coronary angiography confirmed graft patency before the lung volume reduction procedure.

The second patient was a 61-year-old woman who, 12 years previously, had triple coronary artery bypass grafting (saphenous vein grafts to the left anterior descending artery, obtuse marginal, and right coronary arteries). The pleural spaces were not entered at any stage during this procedure. Repeat coronary angiography also confirmed graft patency before the lung volume reduction procedure.

Both patients had single-stage, bilateral, apical LVR (removing 20% to 30% of lung volume) through bilateral muscle-sparing anterior thoracotomies. The preoperative, perioperative, and postoperative methods used were similar to those described by de Perrot and associates, although neither patient had a talc pleurodesis or an apical pleural tent. In the first patient, division of retrosternal adhesions between the two lungs was facilitated by linear staples reinforced by bovine pericardial strips. The second patient had dense left basal adhesions despite the pleural space not being opened during the coronary artery bypass operation. In each patient the adhesions were satisfactorily approached and divided by means of the anterior muscle-sparing thoracotomies. At present, the first patient had marked relief of dyspnea and had a 45% improvement in forced expiratory volume in 1 second at 6 months after LVR. The second patient was still convalescing in the hospital 2 weeks after LVR.

It is inevitable that patients who previously had a cardiac surgical procedure (especially coronary artery bypass grafting in patients with a history of heavy smoking) will continue to be referred for LVR. Our practice is to evaluate each patient on their merits from the respiratory point of view [2] and to confirm coronary artery bypass graft patency by repeat coronary angiography. Should they fulfill the criteria for LVR and be at low risk for a perioperative cardiac event, they are operated on through bilateral muscle-sparing anterior thoracotomies. This approach has been successful in two patients and is recommended for surgeons who prefer the open rather than the thoracoscopic approach to LVR.

References

1. De Perrot M., Licker M., Spiliopoulos A. Muscle-sparing anterior thoracotomy for one-stage bilateral lung volume reduction operation. Ann Thorac Surg 1998;66:582-585.[Abstract/Free Full Text]
2. Snell G.I., Solin P., Chen W., et al. Lung volume reduction surgery for emphysema. Med J Aust 1997;167:529-532.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Julian A. Smith Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Smith, J. A. Search for Related Content PubMed Articles by Smith, J. A.