This was presented at the British Thoracic symposum in December. It basically shows that if the Valve lung reduction fails there is still a chance to do the LVRS
--------------------------
SALVAGE LUNG VOLUME REDUCTION SURGERY AFTER
FAILURE OR COMPLICATIONS OF ENDOBRONCHIAL
TREATMENT WITH ONE-WAY VALVES FOR SEVERE
EMPHYSEMA
Introduction Endobronchial lung volume reduction with one-way
valves (ELVR), in combination with staged unilateral VATS lung
volume reduction surgery (LVRS), multiplicates the options of
treatment for emphysema. No experience has yet been reported
in literature of the use of LVRS after failure of ELVR. We aimed
therefore to review our current series.
Methods 7 consecutive patients (3 male, age 68, 59–76) had successfull
Chartis assessment and ELVR, and subsequently underwent
salvage LVRS following failure or complications of primary
procedure. All patients were suitable candidates for either
approach according to our criteria (average RV/TLC 67 range
56–77, FEV1 32% range 25–38, DLCO 32%, range 24–55),
with 4 patients classifying as moderate to high risk for LVRS and
the rest as moderate or low. They were offered both options and
opted for ELVR on the assumption of reduced risks and shorter
hospitalisation. Valves were not removed prior to LVRS, except
in one case who was also the first chronological patient in our
series.
Results Delayed collateral ventilation with no lobar collapse and
no functional improvement at any time was observed in 3
patients. The remainder had lobar collapse with initial improvement:
of these, 1 developed ipsilateral pneumothorax with persisting
air leak leading to LVRS, 2 developed contralateral upper
lobe compensatory hyperinflation (1R, 1L) and 1 ipsilateral lower
lobe compensatory hyperinflation.
No significant morbidity or 30-day/in-hospital mortality.
Median lenght of stay after LVRS was 11 days (4–34), slightly
longer (19 days, 4–34) for patients who were operated for contralateral
hyperinflation or whose EBV was removed prior to
VATS (no valve in situ on the operated side). Duration of drainage
was also longer in these patients compared to the whole
group, 18 (6–30) vs. 8 (5–30) days. Average EQ-5D score was
49.7 (18.9–71) six months after LVRS, vs. 42 (18.9–81.4) preoperatively,
with only one patient reporting further deterioration.
Conclusion ELVR can be considered as a trial of LVR not precluding
salvage LVRS. Removal of endobronchial valves prior to
surgery seems unnecessary and may actually be protective against
excessive postoperative air leak. Occurrence of compensatory
hyperinflation may suggest that single-stage bilateral ELVR could
also be considered.
www.brit-thoracic.org.uk/document-library/learning-hub/winter-meeting-2016/winter-meeting-2016-programme-and-abstract-book/
