Results of lung volume reduction surgery in patients meeting a national emphysema treatment trial high-risk criterion.
OBJECTIVE
A report from the National Emphysema Treatment Trial indicated that lung volume reduction candidates with a forced expiratory volume in 1 second and a diffusing capacity of carbon monoxide of 20% or less of predicted value were at high risk for mortality and were unlikely to benefit from surgical intervention. This article examines the applicability of the National Emphysema Treatment Trial findings to our own patients.


METHODS
We reviewed 280 patients who underwent bilateral lung volume reduction surgery at our institution between January 1993 and December 2001. All patients met our selection criteria, including heterogeneous distribution of emphysema. Of these 280 patients, 20 patients had both a preoperative forced expiratory volume in 1 second and a diffusing capacity of carbon monoxide of less than or equal to 20% of the predicted normal values, thus meeting one National Emphysema Treatment Trial criterion for high risk. Outcomes of the 20 patients were assessed through 5 years after the operation. The survival of the 20 patient cohort was compared with that of the 260 patients not meeting the National Emphysema Treatment Trial high-risk criterion.


RESULTS
Ninety-day operative mortality included 1 (5%) patient. In all patients the forced expiratory volume in 1 second increased from 0.46 L (17%) to 0.78 L (32%), a 73% change; the diffusing capacity of carbon monoxide increased from 16% to 27%, a 70% improvement; residual volume decreased from 6.33 L (305%) to 4.26 L (205%), a 33% improvement; and room air arterial partial pressure of oxygen increased from 55 mm Hg to 64 mm Hg. Kaplan-Meier 5-year survivals did not differ between the high-risk and non-high-risk groups.


CONCLUSIONS
Patients with a forced expiratory volume in 1 second and a diffusing capacity of carbon monoxide of 20% or less of predicted value might experience improvements in lung function, exercise tolerance, and quality of life with acceptable morbidity and mortality after lung volume reduction surgery.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, 3108 Queeny Tower, St. Louis, MO 63110, USA. meyersb@msnotes.wustl.edu
Bryan F
BF
Meyers
Roger D
RD
Yusen
Tracey J
TJ
Guthrie
G Alexander
GA
Patterson
Stephen S
SS
Lefrak
Gail E
GE
Davis
Joel D
JD
Cooper
D000368:Aged; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011013:Pneumonectomy; D011653:Pulmonary Diffusing Capacity; D011656:Pulmonary Emphysema / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D012307:Risk Factors; D015996:Survival Rate