Obstructive Lung Diseases |

Lung Volume Reduction Surgery (LVRS) in the Lung Allocation Score Era (LAS) FREE TO VIEW

James Maloney*, MD; Nicole Strieter, APRN-BC; Keith Meyer, MD; Tiffany Mack, PA-C; Richard Cornwell, MD
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University of Wisconsin Department of Surgery, Madison, WI

Chest. 2012;142(4_MeetingAbstracts):741A. doi:10.1378/chest.1390193
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SESSION TYPE: COPD: Therapeutic Options

PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM

PURPOSE: The NETT demonstrated improved pulmonary function, quality of life and survival advantage with LVRS. As the LAS shifted the diagnosis of lung transplant recipients, more consideration was given to LVRS. Since 2008, all patients with emphysema referred for lung transplantation were screened for LVRS. We describe our consecutive series of patients undergoing LVRS from January 2008 to December 2011.

METHODS: Retrospective analysis of all patients who underwent LVRS during study time period. Patients were referred directly for LVRS or for transplantation and found to be candidates. Standard NETT criteria and workup were used for patient selection. LOS, ICU stay morbidity and mortality were determined. Quantitative improvement in pulmonary function was assessed at 3 months post procedure with paired student’s t-test. Change oxygen requirement was assessed with fissures exact test. Survival was assessed with Kaplan Meier survival curves.

RESULTS: LVRS was performed on 30 patients during study period.Mean age was 61. Mean pre-operative FEV1and FEV1% were 790ml and 26% predicted, respectively.The median ICU stay was 0 days (mean of 1.7), median LOS was 8 days. Two patients were discharged to skilled nursing facilities. Readmission rate was 7%. 30 and 90-day, 1 and three year mortality were zero. No patients have undergone transplantation. Mean improvement in FEV1 was 512 ml. (p<0.005), a mean increase of 61.4%. 92.6% had decreased oxygen needs and 17/27 (63%) had no supplemental oxygen needs post procedure.

CONCLUSIONS: LVRS results in significant improvement in FEV1 and decreased need for supplemental oxygen that has not been replicated with bronchoscopic techniques. This can be accomplished with acceptable morbidity and very low mortality. This study is unique as all procedures were performed after the adoption of the LAS.

CLINICAL IMPLICATIONS: LVRS should be more broadly offered to appropriate patients with emphysema who may have previously been transplant candidates.

DISCLOSURE: The following authors have nothing to disclose: James Maloney, Nicole Strieter, Keith Meyer, Tiffany Mack, Richard Cornwell

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University of Wisconsin Department of Surgery, Madison, WI




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