Header

UZH-Logo

Maintenance Infos

Lung volume reduction surgery in selected patients with emphysema and pulmonary hypertension


Caviezel, Claudio; Aruldas, Carlson; Franzen, Daniel; Ulrich, Silvia; Inci, Ilhan; Schneiter, Didier; Weder, Walter; Opitz, Isabelle (2018). Lung volume reduction surgery in selected patients with emphysema and pulmonary hypertension. European Journal of Cardio-Thoracic Surgery, 54(3):565-571.

Abstract

OBJECTIVES Pulmonary hypertension (PH) is considered a contraindication for lung volume reduction surgery (LVRS). Because, it has been reported that endobronchial lung volume reduction may have a beneficial effect without increased mortality in patients with emphysema and PH, we evaluated its effect on PH in patients undergoing LVRS. METHODS From January 2014 until June 2016, 119 LVRSs were performed at Zurich University Hospital. PH was a contraindication for patients with homogeneous emphysema but was acceptable for those with heterogeneous emphysema. Thirty patients underwent echocardiography before and after LVRS, 10 of whom had preoperative systolic pulmonary artery pressures >35 mmHg and 20 of whom had normal systolic pulmonary artery pressure. The effect of LVRS on pulmonary artery pressure, lung function and survival was analysed. RESULTS Ninety-day mortality for all 30 patients was 0, and the postoperative course did not differ significantly between the 2 groups. In patients with PH, the median systolic pulmonary artery pressure decreased from 41 mmHg [interquartile range (IQR) 39–47] to 37 mmHg (IQR 36—38, P = 0.04). These patients had an improvement of forced expiratory volume in 1 s from the median 27% predicted (IQR 23–34) to 33% (IQR 28–40, P = 0.007) 3 months postoperatively. CONCLUSIONS If further confirmed in other cohorts, mild to moderate PH may no longer be considered a contraindication for LVRS in patients with heterogeneous emphysema.

Abstract

OBJECTIVES Pulmonary hypertension (PH) is considered a contraindication for lung volume reduction surgery (LVRS). Because, it has been reported that endobronchial lung volume reduction may have a beneficial effect without increased mortality in patients with emphysema and PH, we evaluated its effect on PH in patients undergoing LVRS. METHODS From January 2014 until June 2016, 119 LVRSs were performed at Zurich University Hospital. PH was a contraindication for patients with homogeneous emphysema but was acceptable for those with heterogeneous emphysema. Thirty patients underwent echocardiography before and after LVRS, 10 of whom had preoperative systolic pulmonary artery pressures >35 mmHg and 20 of whom had normal systolic pulmonary artery pressure. The effect of LVRS on pulmonary artery pressure, lung function and survival was analysed. RESULTS Ninety-day mortality for all 30 patients was 0, and the postoperative course did not differ significantly between the 2 groups. In patients with PH, the median systolic pulmonary artery pressure decreased from 41 mmHg [interquartile range (IQR) 39–47] to 37 mmHg (IQR 36—38, P = 0.04). These patients had an improvement of forced expiratory volume in 1 s from the median 27% predicted (IQR 23–34) to 33% (IQR 28–40, P = 0.007) 3 months postoperatively. CONCLUSIONS If further confirmed in other cohorts, mild to moderate PH may no longer be considered a contraindication for LVRS in patients with heterogeneous emphysema.

Statistics

Citations

Dimensions.ai Metrics
2 citations in Web of Science®
4 citations in Scopus®
Google Scholar™

Altmetrics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Pneumology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Thoracic Surgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Surgery, Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine, General Medicine
Language:English
Date:1 September 2018
Deposited On:04 Jan 2019 07:12
Last Modified:25 Jan 2019 15:13
Publisher:Oxford University Press
ISSN:1010-7940
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/ejcts/ezy092
PubMed ID:29538689

Download

Full text not available from this repository.
View at publisher

Get full-text in a library