Reduction Pneumonoplasty for Patients With a Forced Expiratory Volume in 1 Second of 500 Milliliters or Less

Background. Patients with severely impaired pulmonary function are considered at high risk for emphysema operations. We prospectively evaluated 44 patients with a forced expiratory volume in 1 second of 0.5 L or less undergoing reduction pneumonoplasty for dyspnea uncontrolled by medical management (confirmed by Borg and modified Medical Research Council dyspnea scales). Methods. There were 28 men and 16 women (mean age, 66 years) with a mean preoperative forced expiratory volume in 1 second of 0.41 L (range, 0.23 L to 0.50 L). Preoperative therapy consisted of bronchodilators (100% of patients), oxygen (80%), and steroids (72%). Hypercarbia was seen in 80% of patients, and 66% had pulmonary hypertension. Unilateral reduction pneumonoplasty by a video-assisted thoracic surgical approach was performed in 34 patients, 6 patients underwent bilateral reduction pneumonoplasty by a video-assisted thoracic surgical approach, and 4 patients underwent bilateral reduction pneumonoplasty by median sternotomy. Discrete emphysematous regions were resected using staplers with buttressing, and regions of homogeneous emphysema were plicated with KTP or neodymium:yttrium-aluminum garnet laser radiation. Results. There was one death within 30 days, two additional deaths within 60 days, and five additional deaths within 1 year. Hospital stay averaged 12 days. Intensive care unit stay averaged 4 days. Subjective improvement was noted by 89%. Borg and modified dyspnea scores improved from 7.6 to 4.5 ( p < 0.01) and from 3.9 to 2.35 ( p < 0.01), respectively. Forced expiratory volume in 1 second was 0.62 L at 1 year, a 51% improvement ( p < 0.001). Forced vital capacity was 1.32 L preoperatively and 2.05 L at 1 year (a 56% improvement) ( p < 0.001). Conclusions. This experience documents that patients with severely impaired lung function can successfully undergo operation for emphysema. To obtain these results one must tailor the operative approach to the patient’s disease. (Ann Thorac Surg 1997;63:186–92)