Outcome After Lung Volume Reduction Surgery in Patients With Severely Impaired Diffusion Capacity

Caviezel, Claudio; Schaffter, Nadja; Schneiter, Didier; Franzen, Daniel; İnci, İlhan; Opitz, Isabelle; Weder, Walter

doi:10.1016/j.athoracsur.2017.09.006

Cited by 23 publications

(20 citation statements)

References 28 publications

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“…However, in heterogeneous emphysema, the resected tissue is functionless und will not further impair gas exchange, but the patient should profit from the effect of correcting hyperinflation. Recently published by our group (13) and already reported by Ciccone and Cooper in 2003 (5), patients with a diffusion capacity below 20% predicted were operated with zero mortality and a good profit. The 33 patients from Zurich showed preoperative pulmonary function values (FEV1, TLC, RV, RV/TLC) within the usual range for LVRS but had a severely impaired diffusion capacity (median 15%, interquartile range [13][14][15][16][17][18].…”

Section: Impaired Diffusion Capacitymentioning

confidence: 76%

“…Recently published by our group (13) and already reported by Ciccone and Cooper in 2003 (5), patients with a diffusion capacity below 20% predicted were operated with zero mortality and a good profit. The 33 patients from Zurich showed preoperative pulmonary function values (FEV1, TLC, RV, RV/TLC) within the usual range for LVRS but had a severely impaired diffusion capacity (median 15%, interquartile range [13][14][15][16][17][18]. Their lung function significantly improved three months after surgery (FEV1% predicted by 26%) and even the DLCO significantly increased by 60% and remained higher than pre-operative for the subsequent year (FEV1% predicted still 21% higher and DLCO 27 % higher compared to preoperatively).…”

Section: Impaired Diffusion Capacitymentioning

confidence: 76%

“…The most common complication after LVRS in patients with such a low DLCO is prolonged air leak lasting longer than 7 days. This might reflect the overall poor quality of these lungs and should be discussed with the patient preoperatively (13,14).…”

Section: Impaired Diffusion Capacitymentioning

confidence: 99%

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Lung volume reduction surgery beyond the NETT selection criteria

2018

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Lung volume reduction surgery (LVRS) for symptomatic patients with advanced emphysema was proven to be successful in a large randomized multi-center trial (NETT) and in several smaller randomized single center trials. This evidence primarily concerns patients with heterogeneous, upper-lobe predominant emphysema and low exercise tolerance within certain selection criteria regarding lung function values. As the most important effect of LVRS is generated by reducing the hyperinflation, even patients with homogeneous emphysema morphology profit from the procedure. Simultaneously, by removing distended and functionless areas in heterogeneous emphysema, also patients with seriously impaired diffusion capacity, moderate pulmonary arterial hypertension, a history of previous LVRS and alpha-1-antitrypsin-deficiency (AATD) can be considered as candidates for (re-)-LVRS. This article summarizes indications for LVRS in these various subtypes of emphysema patients.

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Section: Impaired Diffusion Capacitymentioning

confidence: 76%

Section: Impaired Diffusion Capacitymentioning

confidence: 76%

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Lung volume reduction surgery beyond the NETT selection criteria

2018

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“…A recent paper by Caviezel et al [2018] demonstrated that DLCO actually significantly improves post-LVRS in patients with a pre-operative DLCO less than 20%, strengthening the argument that resection of non-contributing parenchyma…”

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confidence: 86%

Lung volume reduction surgery in patients with low diffusion capacity

2019

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“…Hyperinflation is also radiologically evaluated using signs such as flattened diaphragm and funnel chest. FEV 1 and diffusion capacity values below 20% predicted are only accepted in cases of heterogeneous emphysema [13] where the target area of resection is (as suggested from perfusion scan and CT scan) obviously functionless lung tissue. Concerning homogeneous emphysema, patients with severe hyperinflation and a D LCO >20% predicted are also considered as possible surgical candidates.…”

Section: Inclusion Criteria For Lvrsmentioning

confidence: 99%

Identification of target zones for lung volume reduction surgery using three-dimensional computed tomography rendering

et al. 2020

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BackgroundThe key issues for performing lung volume reduction surgery (LVRS) is the identification of the target zones. Recently introduced three-dimensional computed tomography rendering methods are used to identify the morphological distribution and its severity of lung emphysema by densitometry. We demonstrate a new software for emphysema imaging and show the pre- and post-operative results in patients undergoing LVRS planned based on this new technology.MethodsA real-time three-dimensional image analysis software system was used pre- and 3 months post-operatively in five patients with heterogeneous emphysema and a single patient with homogeneous morphology scheduled for LVRS. Focus was on low attenuation areas with <950 HU, distribution on both lungs and the value of the three-dimensional images for planning surgery. Functional outcome was assessed by pulmonary function tests after 3 months.ResultsFive patients underwent bilateral LVRS and one patient had unilateral LVRS. All patients showed a median increase in forced expiratory volume in 1 s of 70% (range 30–120%), compared with baseline values. Hyperinflation (expressed as residual volume/total lung capacity ratio) was reduced by 30% (range 5–32%). In the patients with heterogeneous emphysema, the pre- and post-operative computed tomography scans and the densitometries showed a decrease in low attenuation areas by 23% (right side) and by 17% (left side), respectively.ConclusionWe demonstrate three-dimensional computed tomography-rendered images for planning personalised remodelling of hyperinflated lungs using LVRS. This user-friendly software has the potential to assist surgeons and interventional pulmonologists to select patients and to visualise target areas in LVRS procedures.

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Outcome After Lung Volume Reduction Surgery in Patients With Severely Impaired Diffusion Capacity

Abstract: Selected patients with severely impaired Dlco of less than 20% can cautiously be considered as potential candidates if hyperinflation is severe and the lungs show areas with advanced destruction as targets for resection.

Cited by 23 publications

References 28 publications

Lung volume reduction surgery beyond the NETT selection criteria

Lung volume reduction surgery beyond the NETT selection criteria

Lung volume reduction surgery in patients with low diffusion capacity

Identification of target zones for lung volume reduction surgery using three-dimensional computed tomography rendering

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