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J Thorac Cardiovasc Surg 2007;133:71-73
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Discussion

Dr John D. Mitchell (Denver, Colo). Doug, I want to congratulate you and your coinvestigators on this very nice study, article, and presentation. Two of the biggest problems with surgical LVRS are the attendant morbidity and mortality associated with the procedure and the cost. One would hope that the development of less-invasive endobronchial therapies, such as this valve, could lead to expansion of the subgroup of patients with emphysema who might benefit from LVRS with less risk and at a lesser cost.

I just have a couple of questions for you. First, I wonder whether you could comment on some of the technical aspects of valve implantation. Is general anesthesia necessary? Are some segments and subsegments harder to instrument than others? And is this what led to considerable variation or range of the procedure times seen in the study?

Dr Wood. In terms of the first part of that question, general anesthetic is probably not necessary. We chose to use general anesthesia in this initial experience to decrease the possible technical difficulties and variability of doing this in an awake patient. All that said, I think that even later, as we gain experience, there still might be some benefit of doing it with a general anesthetic. There is a lot of airway manipulation of multiple segments, and it is very easy to do with a patient anesthetized. I think that the aspect of cough or respiratory movement might make some of those adjustments and placement of the valve more difficult. I do not have experience with that yet, but I can anticipate that that might be the case.

In terms of segments that are more difficult: yes, there are. As you get more acute angles into the anterior segments of both upper lobes, those can sometimes be . . . [Full Text of this Article]

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A multicenter trial of an intrabronchial valve for treatment of severe emphysema

Douglas E. Wood, Robert J. McKenna, Jr, Roger D. Yusen, Daniel H. Sterman, David E. Ost, Steven C. Springmeyer, H. Xavier Gonzalez, Michael S. Mulligan, Thomas Gildea, Ward V. Houck, Michael Machuzak, and Atul C. Mehta
J. Thorac. Cardiovasc. Surg. 2007 133: 65-73. [Abstract] [Full Text] [PDF]