Outcomes after unilateral lung volume reduction.
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 (FEV(1)) from postrehabilitation values was 32% at 6 months (p <or= 0.001) and 28% at 3 years (p = 0.036). The FEV(1) was not significantly improved at 5 years. The mean reduction in residual volume after ULVRS was 23% at 6 months (p <or= 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.
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO 63110-1013, USA. meyersb@wustl.edu
Bryan F
BF
Meyers
Parvez K
PK
Sultan
Tracey J
TJ
Guthrie
Stephen S
SS
Lefrak
Gail E
GE
Davis
G Alexander
GA
Patterson
Joel D
JD
Cooper
Roger D
RD
Yusen
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011659:Pulmonary Gas Exchange; D011788:Quality of Life; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013908:Thoracotomy; D016896:Treatment Outcome