Two-year results after lung volume reduction surgery in alpha1-antitrypsin deficiency versus smoker's emphysema

Cassina, Paolo C.; Teschler, Helmut; Konietzko, N.; Theegarten, Dirk; Stamatis, Georgios

doi:10.1183/09031936.98.12051028

Cited by 94 publications

(73 citation statements)

References 14 publications

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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].…”

Section: Discussionmentioning

confidence: 97%

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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Section: Discussionmentioning

confidence: 97%

Lung volume reduction surgery versus conservative treatment in severe emphysema

Wilkens

Demertzis²,

König

et al. 2000

Eur Respir J

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“…Secondly, the elastase-induced emphysema is diffuse and very closely simulates human panlobular emphysema [19]. LVRS in panlobular emphysema associated with a 1 -antitrypsin deficiency has provided conflicting results in the long term [20,21]. Nevertheless, short-term results are consistently favourable, suggesting that poor longterm results are due to accelerated loss of the effect after surgery.…”

Section: Discussionmentioning

confidence: 99%

Effects of lung volume reduction surgery in hamsters with elastase-induced emphysema

Marchand¹,

Leyn²,

Gayan‐Ramirez³

et al. 2002

Eur Respir J

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Lung volume reduction surgery (LVRS) has been shown to improve respiratory mechanics in selected patients with severe emphysema. This is thought to be due to an improvement in lung elastic recoil. This study was aimed at gaining further understanding about the effects of LVRS on respiratory mechanics and airway function.Control hamsters instilled with saline (Ctrl; n=8) were compared with emphysematous animals that underwent either a sham operation (Sham; n=7) or an LVRS (LVRS; n=7).As expected, there was a significant increase in the static lung volumes in the Sham as compared to the Ctrl group and a significant decrease of these volumes in LVRS as compared to the Sham group. Surprisingly, emphysema was associated with a significant increase and LVRS with a significant decrease in vital capacity. Despite a tendency toward an increase in lung compliance as compared to Sham, indices of maximal expiratory flows tended to decrease with LVRS. As opposed to humans, there was no change in the distribution of airway diameters in Sham compared to Ctrl.These findings appear to be largely explained by the high compliance of the hamster chest wall. This allows for better matching between the emphysematous lung and the chest-wall sizes than in humans.

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“…Volume reduction procedures that do not cause pleural scarring may be more effective than conventional LVRS for treating lower-lobe emphysema by reducing lung volume without causing formation of peridiaphragmatic scar tissue that can restrict diaphragm motion (13,14). BLVR procedures that can be performed at the bedside and administered using a gradual, stepwise approach could potentially facilitate weaning of patients with emphysema with chronic respiratory failure from mechanical ventilation (15).…”

Section: Rationale For Pursuing Blvrmentioning

confidence: 99%

Bronchoscopic Lung Volume Reduction in Severe Emphysema

Ingenito¹,

Wood²,

Utz³

2008

Proceedings of the American Thoracic Society

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Lung volume reduction surgery (LVRS) produces physiological, symptomatic, and survival benefits in selected patients with advanced emphysema. Because it is associated with significant morbidity, mortality, and cost, nonsurgical alternatives for achieving volume reduction have been developed. Three bronchoscopic lung volume reduction (BLVR) approaches have shown promise and reached later-stage clinical trials. These include the following: (1) placement of endobronchial one-way valves designed to promote atelectasis by blocking inspiratory flow; (2) formation of airway bypass tracts using a radiofrequency catheter designed to facilitate emptying of damaged lung regions with long expiratory times; and (3) instillation of biological adhesives designed to collapse and remodel hyperinflated lung. The limited clinical data currently available suggest that all three techniques are reasonably safe. However, efficacy signals have been substantially smaller and less durable than those observed after LVRS. Studies to optimize patient selection, refine treatment strategies, characterize procedural safety, elucidate mechanisms of action, and characterize short-and longer-term effectiveness of these approaches are ongoing. Results will be available over the next few years and will determine whether BLVR represents a safe and effective alternative to LVRS.

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Two-year results after lung volume reduction surgery in alpha1-antitrypsin deficiency versus smoker's emphysema

Cited by 94 publications

References 14 publications

Lung volume reduction surgery versus conservative treatment in severe emphysema

Lung volume reduction surgery versus conservative treatment in severe emphysema

Effects of lung volume reduction surgery in hamsters with elastase-induced emphysema

Bronchoscopic Lung Volume Reduction in Severe Emphysema

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