title: Feasibility and Safety of a Transthoracic Pneumostoma Airway Bypass in Severe Emphysema Patients.
abstract: BACKGROUND
  Emphysema is characterised by airflow obstruction, hyperinflation, and resultant dyspnoea. It is worth investigating whether decompression improves lung mechanics and enhances quality of life (QoL).
  
  
  OBJECTIVE
  The purpose of this study was to describe the feasibility and safety of creating a transthoracic pneumostoma to enable lung reduction.
  
  
  METHODS
  A transthoracic 10-mm diameter Portaero Access Tube (Portaero™, Cupertino, CA, USA) was implanted via a third intercostal space incision in 15 severe emphysema patients [mean age 63 years, forced expiratory volume in 1 s 54% predicted, diffusing capacity for carbon monoxide 31% predicted, residual volume 246% predicted, Six-Minute Walk Test 296 m]. Four weeks later, an 8-mm Portaero Disposable Tube (3-8 cm in length) was substituted and changed daily thereafter. The targeted primary endpoints were a ≥12% increase in forced expiratory volume in 1 s and a decrease of ≥4 points in Saint George's Respiratory Questionnaire score at 6 months.
  
  
  RESULTS
  Sixteen procedures were performed on 15 patients, complicated by 1 intercostal haemorrhage, 1 pneumothorax, and universal mild surgical emphysema. Early patency issues were common, but often responded to external endoscopic debridement or argon plasma laser. Three-month patency was achieved in 9 of 15 patients, and 6 of these had long-term patency (mean of 4 years). Patency was associated with potentially useful long-term improvements or stability in spirometry, residual volume, and QoL. However, the primary endpoints were not met at 6 months.
  
  
  CONCLUSIONS
  The creation and maintenance of a transthoracic pneumostoma appears feasible and safe in patients with severe emphysema. Further studies refining patient selection (perhaps via chest computed tomography collateral ventilation and fissure assessments), techniques, and tube materials are suggested.
authors.affiliation: Lung Transplant Service, Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Gregory I
authors.initials: GI
authors.lastname: Snell
authors.forename: Lynda
authors.initials: L
authors.lastname: Holsworth
authors.forename: Sadie
authors.initials: S
authors.lastname: Khorramnia
authors.forename: Glen P
authors.initials: GP
authors.lastname: Westall
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Williams
authors.forename: Silvana
authors.initials: S
authors.lastname: Marasco
authors.forename: Julian H
authors.initials: JH
authors.lastname: Gooi
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D054047:Surgical Stomas; D014797:Vital Capacity