BACKGROUND: Bronchoscopic valve placement constitutes an effective endoscopic lung volume reduction (ELVR) therapy in patients with severe emphysema and low collateral ventilation. After occluding the most destroyed lobe with valves, significant target lobe volume reduction leads to improvements in lung function, exercise capacity, and quality of life. In some patients, the effects are not consistent leading to long-term therapy failure. We hypothesized that surgical lung volume reduction (LVRS) would re-establish ELVR short-term clinical improvements following ELVR long-term failure. METHODS: In this retrospective single-center analysis, we included all patients who underwent consolidating lung volume reduction surgery (LVRS) by lobectomy after long-term failure of valve therapy between 2010 and 2015. Changes in forced expiratory volume in 1 second (FEV1), residual volume (RV), 6-min walking distance (6MWD), and dyspnea score (mMRC) 90 days after ELVR and LVRS were analyzed, and the outcomes of both procedures were compared. RESULTS: A total of 20 patients underwent LVRS after ELVR failure. In the majority (90%), a lower lobectomy was performed. The 30-day mortality of the cohort was 0% and 90-day mortality 5% (1/20). The remaining 19 patients showed a significant increase in FEV1 (+27.5 ± 19.4%) and reduction in RV (-21.0 ± 17.4%) and TLC (-11.1 ± 11.1%). This resulted in significant improvements in exercise tolerance (6MWD: +56 ± 60 m) and relief of dyspnea (ΔmMRC: -1.8 ± 1.4 pts.). CONCLUSIONS: Consolidating LVRS by lobectomy after failure of previously successful ELVR is feasible and results in significant symptom relief and improvement of lung function.
- Eichhorn, M. E.
- Gompelmann, D.
- Hoffmann, H.
- Dreher, S.
- Hornemann, K.
- Haag, J.
- Kontogianni, K.
- Heussel, C. P.
- Winter, H.
- Herth, F. J. F.
- Eberhardt, R.
