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Ann Thorac Surg 2008;85:1171-1177. doi:10.1016/j.athoracsur.2007.12.009
© 2008 The Society of Thoracic Surgeons
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Original Articles: General Thoracic

Lung Volume Reduction Reoperations

Federico Tacconi, MD, Eugenio Pompeo, MD*, Daniele Forcella, MD, Mario Marino, MD, Dimitrios Varvaras, MD, Tommaso C. Mineo, MD

Thoracic Surgery Division, Emphysema Center, Policlinico Tor Vergata University, Rome, Italy

Accepted for publication December 3, 2007.

* Address correspondence to Dr Pompeo, Cattedra di Chirurgia Toracica, Policlinico Tor Vergata, V.le Oxford 81, Rome, 00133, Italy (Email: pompeo{at}med.uniroma2.it).

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 respiratory distress syndrome. Hospital stay was 9 ± 2 days. Significant improvements occurred for up to 12 months in forced expiratory volume in 1 second (FEV1; p < 0.001), forced vital capacity (p < 0.002), residual volume (p < 0.001), 6-minute walk test (p < 0.001), and modified Medical Research Council dyspnea index (p < 0.001). At 6-months, improvements in FEV1 were greater than 200 mL in 11 patients and correlated with the postoperative reduction in residual volume (r = –0.62, p = 0.01); baseline residual volume was inversely correlated with the degree of improvement in the dyspnea index (r = –0.54, p = 0.03).

Conclusions: Lung volume reduction reoperations can offer significant clinical improvement to stringently selected patients who have lost the clinical benefit achieved after lung volume reduction surgery.






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