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Ann Thorac Surg 2000;69:1674
© 2000 The Society of Thoracic Surgeons

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Discussion

Discussion

DR E. PENDLETON ALEXANDER (Washington, DC): I enjoyed this paper very much. I wonder if you could comment on how you think the results of the study may have been affected by having more than two-thirds of the patients with postoperative spirometry? And secondly, in terms of functional capacity long-term, is part of the difference between the unilateral and the bilateral approach possibly related to the rate of decline of FEV₁, which may actually be accelerated after lung volume reduction surgery?

Again, thank you, I enjoyed the paper very much.

DR LOWDERMILK: Only two-thirds of our patients were followed up for postop spirometry. I think that may have affected the results. These results are a retrospective review and you could make the argument that the patients that did not show up for follow-up, did not like their operation, or did not do well. This could skew the data and the postoperative spirometry results may have been less favorable.

As far as the increment of improvement, that may be a point later on in deciding to perform unilateral and bilateral lung volume reduction. There may come a time when we may decide that a certain population should undergo a unilateral reduction and gain that benefit, and then undergo another staged procedure to gain even more benefit over a longer period of time to increase survival and increase function.

DR CLAUDE DESCHAMPS (Rochester, MN): Congratulations on your presentation, which is very relevant and important in regarding to the oncoming NETT study. Can you tell us if you have looked at the follow-up of those patients over time and if you have a difference in terms of the decline of the FEV₁ or the deterioration of those patients, unilateral compared to bilateral? Have you seen a difference, since you have a fairly good span of time, 6 years or 5 years?

DR LOWDERMILK: As far as the decline, we did not have enough longitudinal spirometric data to make a meaningful assessment or compare the two groups.

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