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J Thorac Cardiovasc Surg 2007;134:974-981
© 2007 The American Association for Thoracic Surgery

Evolving Technology

Clinical application of airway bypass with paclitaxel-eluting stents: Early results

Paulo F.G. Cardoso, MD, PhDa,*, Gregory I. Snell, MD, MBBS, FRACPb, Peter Hopkins, MDc, Gerhard W. Sybrecht, MDd, Georgios Stamatis, MDe, Alan W. Ng, MDf, Philip Eng, MD, FCCP, FACPg

a Department of Surgery, Division of Thoracic Surgery, Santa Casa de Porto Alegre-Pavilhao Pereira Filho Hospital, Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre, Porto Alegre-RS, Brazil
b Lung Transplant Service Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, Victoria, Australia
c Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
d Klinik fur Innere Medizin, Pneumologie, Allergologie, Beatmungs und Umweltmedizi, Meizinische Universitatsklinik, Saarland, Germany
e Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, Essen, Germany
f Department of Respiratory Medicine, Tan Tock Seng Hospital, Singapore
g Department of Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29–May 3, 2006.

Received for publication April 27, 2006; revisions received April 1, 2007; accepted for publication May 11, 2007.

* Address for reprints: Paulo F. G. Cardoso, MD, Ph.D., Santa Casa de Porto Alegre-Pavilhao Pereira Filho, Rua Prof. Annes Dias 285-1 PPF, Porto Alegre-RS, 90020-090, Brazil. (Email: cardosop{at}gmail.com).

Objective: To assess the safety and early clinical results of a multicenter evaluation of airway bypass with paclitaxel-eluting stents for selected patients with severe emphysema.

Methods: Airway bypass was performed with a fiberoptic bronchoscope in three steps: identification of a blood vessel–free location with a Doppler probe at the level of segmental bronchi, fenestration of the bronchial wall, and placement of a paclitaxel-eluting stent to expand and maintain the new passage between the airway and adjacent lung tissue. All adverse events were recorded, as well as 1- and 6-month pulmonary function tests and dyspnea index.

Results: Thirty-five patients received the airway bypass procedure with a median of 8 stents implanted per patient. At 1-month follow-up, statistically significant differences in residual volume, total lung capacity, forced vital capacity, forced expiratory volume, modified Medical Research Council scale, 6-minute walk, and St George’s Respiratory Questionnaire were observed. At the 6-month follow-up, statistically significant improvements in residual volume and dyspnea were demonstrated. One death occurred after bleeding during the procedure. Retrospective analysis revealed that the degree of pretreatment hyperinflation may be an important indicator of which patients achieve the best short- and long-term results.

Conclusions: The airway bypass procedure reduces hyperinflation and improves pulmonary function and dyspnea in selected patients with severe emphysema. Duration of benefit appears to correlate with the degree of pretreatment hyperinflation. These preliminary clinical results support further evaluation of the procedure.

Abbreviations and Acronyms COPD = chronic obstructive pulmonary disease; FEV1, FEV5 = forced expiratory volumes in 1 and 5 seconds; FVC = forced vital capacity; 6MW = 6-minute walk; mMRC = modified Medical Research Council; NETT = National Emphysema Treatment Trial; RV = residual volume; SGRQ = St George’s Respiratory Questionnaire; TLC = total lung capacity


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J. Thorac. Cardiovasc. Surg. 2007 134: 980-981. [Extract] [Full Text] [PDF]





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