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J Thorac Cardiovasc Surg 2004;127:1564-1573
© 2004 The American Association for Thoracic Surgery
General thoracic surgery |
a Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
b Department of Diagnostic and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
c Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
Received for publication June 25, 2003; revisions received September 3, 2003; revisions received October 2, 2003; accepted for publication October 3, 2003.
* Address for reprints: Anthony P. C. Yim, MD, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
yimap{at}cuhk.edu.hk
BACKGROUND: We determined the feasibility, safety, and short-term efficacy of bronchoscopic placement of a one-way endobronchial valve in selected bronchopulmonary segments as an alternative to surgical lung volume reduction.
METHODS: A total of 21 patients with incapacitating emphysema who underwent this procedure were studied. All patients had placement of the endobronchial valves into the most emphysematous lung segments. We recorded any major complications or deaths attributed to the procedure and analyzed (1) improvements in the spirometric and functional parameters and quality of life and (2) the radiologic changes compared with the baseline data at 30 and 90 days.
RESULTS: A total of 20 patients had complete follow-up data. There was no mortality in the group studied. The forced expiratory volume at 1 second, forced expiratory volume at 1 second (percentage of predicted), forced vital capacity, and forced vital capacity (percentage of predicted) all improved significantly at 90 days (0.73 ± 0.26 L vs 0.92 ± 0.34 L [P = .009]; 33.3% ± 11.9% vs 42.2% ± 15.0% [P = .006]; 1.94 ± 0.62 L vs 2.25 ± 0.61 L [P = .015]; and 63.3% ± 17.6% vs 73.9% ± 17.1% [P = .012], respectively). The 6-minute walking distance improved at 30 and 90 days (251.6 ± 100.2 m vs 306.3 ± 112.3 m and 322.3 ± 129.7 m; P = .012 and P = .003). The results of the 36-Item Short-Form Health Survey and the St George Respiratory Questionnaire showed significant improvements at 90 days. The Medical Research Council dyspnea grade also improved significantly at 30 and at 90 days (P = .006 and P = .003, respectively).
CONCLUSIONS: Endobronchial valve placement is a safe procedure, with significant short-term improvements in functional status, quality of life, and relief of dyspnea in selected patients with emphysema. A larger study with long-term follow-up is therefore warranted.
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