Long-Term Survival Analysis of the Canadian Lung Volume Reduction Surgery Trial

Agzarian, John; Miller, John D.; Kosa, Sarah Daisy; Malthaner, Richard; Tan, Lawrence

doi:10.1016/j.athoracsur.2013.04.077

Cited by 11 publications

(3 citation statements)

References 11 publications

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“…Shigemura et al [ 21 ] reported that secondary severe pulmonary hypertension, prolonged cardiopulmonary bypass, and high transfusion requirements occurred after LVRS. However, the Canadian Lung Volume Reduction Surgery Group (CLVRS) evaluated patients at 2, 4, 6, and 8 years after LVRS and observed a potential long-term benefit in the survival rates [ 17 , 22 ]. In addition, NETT studies evaluated patients from 90 days to 4 years of follow-up and concluded that LVRS is an effective treatment option for severe emphysema [ 2 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Compensatory lung growth after bilobectomy in emphysematous rats

Almeida¹,

Saraiva-Romanholo²,

Moriya³

et al. 2017

PLoS ONE

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Lung volume reduction surgery (LVRS) is an option for emphysematous patients who are awaiting lung transplantation. LVRS reduces nonfunctional portions of lung tissues and favors the compensatory lung growth (CLG) of the remaining lobes. This phenomenon diminishes dyspnea and improves both the respiratory mechanics and quality of life for the patients. An animal model of elastase-induced pulmonary emphysema was used to investigate the structural and functional lung response after LVRS. Bilobectomy was performed six weeks after elastase instillation. Two weeks after bilobectomy, CLG effects were evaluated by lung mechanics and histomorphometric analysis. After bilobectomy, the emphysematous animals presented decreased mean linear intercepts, increased elastic fiber proportion, and increased alveolar surface density, total volumes of airspace, tissue and respiratory region and absolute surface area. We conclude that bilobectomy promoted CLG in emphysematous animals, resulting in alveolar architecture repair.

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Section: Discussionmentioning

confidence: 99%

Compensatory lung growth after bilobectomy in emphysematous rats

Almeida¹,

Saraiva-Romanholo²,

Moriya³

et al. 2017

PLoS ONE

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“…Briefly, LVRS should be considered for patients with an upper-lobe predominant emphysema, an FEV 1 between 45% and 20% of the predicted value and a DLCO not less than 20% as those patients will have a significant advantage in exercise capacity and dyspnea related quality of life (10). Findings of the NETT trial have been reproduced in a study of the STS database (11) and in the Canadian Lung Volume Reduction Surgery (CLVRS) trial (12). The first, compared post-operative results of 538 patients to the data published in the NETT trial (n=608).…”

Section: Patient Selection For Lvrsmentioning

confidence: 99%

Lung volume reduction followed by lung transplantation—considerations on selection criteria and outcome

Slama¹,

Taube²,

Kamler³

et al. 2018

J. Thorac. Dis

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Lung transplantation (LuTX) and lung volume reduction (LVR), either surgical (LVRS: lung volume reduction surgery) or endoscopic (ELVR: endoscopic lung volume reduction), are established therapies in the treatment of end-stage chronic obstructive pulmonary disease (COPD) patients. Careful patient selection is crucial for each intervention. If these techniques are sequentially applied there is a paucity of available data and individual center experiences vary depending on details in selection criteria and operative technique. This review aims to summarize the published data with a focus on LuTX after LVRS. This review covers patient selection for LuTX and LVR, technical considerations, limitations and outcomes. Published literature was identified by systematic search on Medline and appropriate papers were reviewed. Seven case reports/series, 7 comparative observational studies and one multicenter database analysis incorporating a total of 284 patients with LuTX and LVR were evaluated. Prior LVR can significantly affect intraoperative and postoperative risks after subsequent LuTX. Careful patient selection and timing and the choice of appropriate techniques such as minimal invasive LVRS and using ECMO as extracorporeal support during LuTX if required can minimize those risks, ultimately leading to very good postoperative outcomes in terms of lung function and survival. LVRS has the potential to delay listing and to bridge patients to LuTX by improving their physical condition while on the waiting list. After single lung transplantation (SLuTX) contralateral LVRS can counteract the deleterious effects of native lung hyperinflation (NLH). LVR and LuTX are adjunct therapies in the treatment of end-stage COPD. The combination of both can safely be considered in selected patients.

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“…[6][7][8] After recovering from the procedure, patients experience improved lung function, resulting in increased exercise tolerance, increased body mass index, and decreased COPD exacerbations that are not observed with pulmonary rehabilitation or medical therapy alone. [9][10][11][12][13] Cost-benefit analysis and cost per quality life years gained make LVRS an expensive, but effective, treatment for these patients. 14,15 Advances in minimally invasive surgery along with refinement of surgical technique continue to improve the outcomes associated with LVRS.…”

mentioning

confidence: 99%