Radiologic emphysema morphology is associated with outcome after surgical lung volume reduction

Weder, Walter; Thurnheer, Robert; Stammberger, Uz; Bürge, Markus; Russi, Erich W.; Bloch, Konrad E.

doi:10.1016/s0003-4975(97)00564-x

Cited by 131 publications

(91 citation statements)

References 6 publications

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“…Such a hypothesis implies that patients with heterogeneous emphysema would benefit more from an intervention targeted at removing the more affected areas than patients with more homogeneous forms of the disease. This is supported by preliminary results showing that patients with inhomogeneous emphysema on imaging demonstrate greater FEV1 improvement after LVRS [76,77].…”

Section: Static Mechanics Of the Respiratory Systemsupporting

confidence: 61%

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Marchand¹,

Gayan‐Ramirez²,

Leyn³

et al. 1999

Eur Respir J

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Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we? E. Marchand, G. Gayan-Ramirez, P. De Leyn, M. Decramer. #ERJ Journals Ltd 1999. ABSTRACT: Lung volume reduction surgery has become an accepted therapeutic option to relieve the symptoms of selected patients with severe emphysema. In a majority of these patients, it causes objective as well as subjective functional improvement. A proper understanding of the physiological determinants underlying these beneficial effects appears very important in order to better select patients for the procedure that is currently largely carried out on an empirical basis.Lung volume reduction surgery has two distinct effects. Firstly, it causes an increased elastic recoil, which at least partially explains the enhanced maximal expiratory flow. Secondly, it is associated with a reduction of hyperinflation which allows for an increase in global inspiratory muscle strength and in diaphragmatic contribution to tidal volume as well as a decrease in the inspiratory elastic load imposed by the chest wall. Taken together, these effects result in a reduced work of breathing and in an enhanced maximal ventilation which both contribute to the increased exercise capacity and reduced dyspnoea after surgery. The improved lung recoil and the reduced hyperinflation after volume reduction surgery were the primary postulates upon which the usual selection criteria for the procedure were based. It is now likely that these are correct. Nevertheless, some patients do not benefit from lung volume reduction surgery and the current literature does not allow for a refinement of the selection process from a physiological point of view.The exact mechanisms underlying the improvement in lung recoil, lung mechanics, and respiratory muscle function remain incompletely understood. Moreover, the effects of lung volume reduction surgery on gas exchange and pulmonary haemodynamics still need to be more fully investigated. An analysis of the characteristics of patients who do not benefit from the procedure and the development of an animal model for lung volume reduction surgery would probably help address these important issues. Eur Respir J 1999; 13: 686±696.

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Section: Static Mechanics Of the Respiratory Systemsupporting

confidence: 61%

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Marchand¹,

Gayan‐Ramirez²,

Leyn³

et al. 1999

Eur Respir J

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“…Patient selection and analysis of data might explain these differences [27,28]. The present patients had mostly homogeneous emphysema, whereas, in other groups, patients with bullous disease were included [29]. Analysis of data was performed at scheduled time points in the present study; other groups may have compared preoperative lung function with best postoperative values.…”

Section: Discussionmentioning

confidence: 98%

Lung volume reduction surgery versus conservative treatment in severe emphysema

Wilkens

Demertzis²,

König

et al. 2000

Eur Respir J

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Lung volume reduction surgery (LVRS) has been proposed for patients with severe emphysema to improve dyspnoea and pulmonary function. It is unknown, however, whether prognosis and pulmonary function in these patients can be improved compared to conservative treatment.The effect of LVRS and conservative therapy were compared prospectively in 57 patients with emphysema, who fulfilled the standard criteria for LVRS. The patients were divided into two groups according to their own decision. Patients in group 1 (n=29, eight females, meanSEM 58.81.7 yrs, forced expiratory volume in one second (FEV1) 27.61.3% of the predicted value) underwent LVRS. Patients in group 2 (n=28, five females, 58.51.8 yrs, FEV1 30.81.4% pred) preferred to postpone LVRS. There were no significant differences in lung function between the two groups at baseline; however, there was a tendency towards better functional status in the control group. The control group had a better modified Medical Research Council (MMRC) dyspnea score (3.10.15 versus 3.50.1, p<0.04).Model-based comparisons were used to estimate the differences between the two groups over 18 months. Significant improvements were observed in the LVRS group compared to the control group in FEV1, total lung capacity (TLC), Residual volume (RV), MMRC dyspnea score and 6-min walking distance on all follow up visits. The estimated difference in FEV1 was 33% (95% confidence interval 13±58%; p>0.0001), in TLC 12.9% (7.9±18.8%; p>0.0001), in RV 60.9% 32.6±89.2%; p>0.0001), in 6-min walking distance 230 m (138±322 m; p<0.002) and in MMRC dyspnoea score 1.17 (0.79±1.55; p<0.0001).In conclusion, lung volume reduction surgery is more effective than conservative treatment for the improvement of dyspnoea, lung function and exercise capacity in selected patients with severe emphysema.

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“…Özellikle büllöz akciğer hastalarında pnömotoraks varlığında tedavi yetersizliği sonucu morbidite ve mortalite oranları yüksek olmaktadır. [1][2][3] Bu hasta gruplarında hava kaçağı ameliyat sonrası dönemde önemli bir sorundur. [4] Sekonder spontan pnömotorakslı hasta grubunda, patolojiye bağlı olarak akciğerin hasar derecesi önemlidir.…”

Section: Discussionunclassified

“…Birçok yazar akciğer harabiyetinin büyük, solunum fonksiyonlarının kısıtlı olduğu grup 2'de komplikasyonlar dışında cerrahi tedavi önermemektedir. [1][2][3] 1990'lı yıllara kadar komplikasyonsuz heterojen amfizemli hastalarda cerrahi tedavinin yeri tartışmalı idi. Fakat son yıllarda hacim küçültücü ameliyat olarak bilinen cerrahi teknik yaygınlık kazanmasına rağmen, [5][6][7][8][9][10] pratikte uygulanması yüksek ameliyat sonrası morbiditeye neden olabileceğinden doğru hasta seçimi önemlidir.…”

Section: Discussionunclassified

“…Uzamış hava kaçağı cerrahide primer sorundur. [1,2] Bunu önlemek için birçok teknik ve malzeme kullanılmaktadır. Biz de çalışma-mızda; pnömotoraks ile komplike olmuş büllöz akciğer hastalıklarında cerrahi tedavi sonuçlarını değerlendir-mek ve sekonder spontan pnömotorakslı hastalarda politetrafloroetilen (PTFE) greft desteğinin uzamış hava kaçağı ve komplikasyonlar üzerinde etkisini araştırmayı hedefledik.…”

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Comparative results of surgical treatment of bullous lung diseases complicated with pneumothorax and the use of polytetrafluoroethylene graft support

Şengül¹

2013

Turk Gogus Kalp Dama

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Amaç: Büllöz akciğer hastalıklarında politetrafloroetilen (PTFE) greft kullanımının komplikasyonları azaltmadaki etkinliği araştırıldı. Ça lış ma pla nı: Ocak 2004 -Aralık 2012 tarihleri arasında spontan pnömotoraks ile komplike olmuş büllöz akciğer hastalığı olan 22 hasta çalışmaya alındı. Hastalar iki gruba ayrıldı. Grup 1'de 10 hastada heterojen amfizematöz hastalık, grup 2'de ise 12 hastada homojen amfizematöz hastalık vardı. Her iki gruba da kas korumalı torakotomi yapıldı. Stapler kullanılarak kama rezeksiyon uygulandı. Grup 1'de altı, grup 2'de beş hastanın rezeksiyon hattı genişleyebilen PTFE greft ile desteklendi. Tedavi sonuçları ve komplikasyonlar gruplar arasında karşılaştırıldı. Bul gu lar: Tedavi sonucunu belirleyen en önemli kriter amfizemin alt tipi idi. Her iki amfizem alt tipi için PTFE greft destek kullanımının komplikasyonlar üze-rine etkisi görülmemesine karşılık, bunun göğüs tüpü çekilme süresini ve hastanede kalış süresini kısalttığı görüldü. So nuç: Tedavi sonucunu belirleyen en önemli kriterin amfizem alt tipi olduğu, her iki amfizem alt tipi için PTFE destek kullanımının komplikasyonlar üzerine etkisi görülmemesine karşılık, göğüs tüpü çekilme süresini ve hastanede kalış süresini kısalttığı görüldü.Anah tar söz cük ler: Büllöz akciğer; pnömotoraks; politetrafloroetilen greft.

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Radiologic emphysema morphology is associated with outcome after surgical lung volume reduction

Cited by 131 publications

References 6 publications

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Lung volume reduction surgery versus conservative treatment in severe emphysema

Comparative results of surgical treatment of bullous lung diseases complicated with pneumothorax and the use of polytetrafluoroethylene graft support

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