Functional comparison of unilateral versus bilateral lung volume reduction surgery.
BACKGROUND
Lung volume reduction surgery (LVRS) has shown early promise as a palliative therapy in severe emphysema. A number of patients, however, are not candidates for a bilateral operation, or exhibit a predominantly unilateral disease distribution.


METHODS
Over 20 months, we performed LVRS in 92 patients selected on the basis of severe hyperinflation with air trapping, diaphragmatic dysfunction, and disease heterogeneity. Twenty-eight patients underwent unilateral LVRS on the basis of asymmetric disease distribution, prior thoracic operation, or concomitant tumor resection.


RESULTS
Unilateral LVRS resulted in comparable improvements in exercise capacity and dyspnea as the bilateral procedure, with a similar perioperative mortality and actuarial survival to 24 months. Improvements in spirometric indices of pulmonary function, however, were less in patients undergoing unilateral than bilateral LVRS.


CONCLUSIONS
In properly selected patients, unilateral LVRS provides functional and subjective benefits of comparable magnitude to those associated with a bilateral operation. Unilateral LVRS is therefore an option in the therapy of end-stage emphysema in patients with asymmetric disease distribution, a prior thoracic operation, or contraindications to sternotomy, and may have a role as a bridge to transplantation in selected cases.
Argenziano
M
M
Division of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Thomashow
B
B
Jellen
P A
PA
Rose
E A
EA
Steinglass
K M
KM
Ginsburg
M E
ME
Gorenstein
L A
LA
D000368:Aged; D000369:Aged, 80 and over; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D014797:Vital Capacity