Lung Volume Reduction Reoperations

Abstract

Background. Optimal management of emphysematous patients who have lost the benefits achieved after lung volume reduction surgery is a clinical dilemma. We have hypothesized that in stringently selected instances, lung volume reduction reoperations might be considered as a salvage surgical treatment. We sought to analyze the results of a series of patients undergoing lung volume reduction reoperations after successful bilateral lung volume reduction surgery.Methods. Between January 2000 and April 2006, 17 patients (mean age, 66 ؎ 3 years) with radiologic evidence of distinct regional lung hyperinflation underwent lung volume reduction reoperations. Surgical procedures entailed completion lobectomy in 7 patients, nonanatomic resection of lung target areas were performed in 5 patients under general anesthesia with one-lung ventilation, and awake lung plication was performed in 5 patients under sole epidural anesthesia. Follow-up at 6 and 12 months was complete in all survivors.Results. Mean operative time was 100 ؎ 12 minutes. Two patients (11.7%) died perioperatively of adult respi-

Repeated lung volume reduction surgery is successful in selected patients

“…Re-LVRS has so far been reported in a case report as well as in one small retrospective study; beneficial effects of Re-LVRS were suggested in some patients [16,17]. However, high mortality and morbidity were reported, particularly due to the high-risk population of end-stage emphysema patients in the setting of a reoperation, with a higher incidence of ARDS in these patients compared with the first-time LVRS population [17].…”

“…Data regarding the feasibility and safety of Re-LVRS are scarce. However, a first case was described by Stammberger et ali n2 0 0 0 [ 16], after which the beneficial effects of Re-LVRS on pulmonary function and quality of life were shown in a small population of 16 patients [17]. However, while it was technically feasible and led to overall improvements, the reported mortality rate was as high as 11.7%, rendering it a high-risk operation [17].…”

Lung volume reduction surgery for the management of refractory dyspnea in chronic obstructive pulmonary disease

“…In patients who have previously undergone successful LVRS but have lost the clinical benefit of the surgery, reoperation and resection of hyperinflated lung tissue has been shown to improve FEV1, forced vital capacity (FVC), residual volume (RV), 6 min walking distance, and dyspnea in one series [6 ]. However, the benefits have only been proven in the short term, and the patients selected met numerous strict criteria.…”

Bronchoscopic treatment of emphysema: an update

“…However, as for LVRS, the functional improvement obtained by EBV progressively declines to pre-treatment levels. For this reason, a second contralateral treatment has been successfully attempted after unilateral LVRS (52,53). This strategy was performed also after valve implantation with encouraging results (54).…”