Endobronchial treatment of giant emphysematous bullae with one-way valves: a new approach for surgically unfit patients
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- 作者：Mario Santini ; ; ; mario.santini@unina2.it ; Alfonso Fiorelli ; Giovanni Vicidomini ; Vincenzo Giuseppe Di Crescenzo ; Gaetana Messina ; Paolo Laperuta
- 关键词：Emphysema ; Bulla ; Endobronchial one-way valves
- 刊名：European Journal of Cardio-Thoracic Surgery
- 出版年：2011
- 出版时间：December 2011
- 年：2011
- 卷：40
- 期：6
- 页码：1425-1431
- 全文大小：539 K
文摘
Objective: We aimed to evaluate the feasibility and short-term efficacy of endobronchial treatment with one-way valves for giant emphysematous bulla in surgically unfit patients. Methods: Nine consecutive patients with giant emphysematous bulla were enrolled in the last 3 years. Endobronchial valves were placed in the segmental bronchi to functionally isolate the airway that supplied the bulla, favouring the deflation of the bulla and its atelectasis. Mean value ¡À standard deviation of forced expiratory volume in 1 s (FEV1), preoperative forced vital capacity (FVC) and residual volume (RV) were: 1.0 ¡À 0.2 l (35 ¡À 9.9 % ), 1.5 ¡À 0.5 l (42 ¡À 12 % ) and 5.5 ¡À 0.7 l (231 ¡À 32 % ), respectively; and the values for diffusion capacity for carbon monoxide was 31 ¡À 4.6 % and for the 6-min walk test (6MWT) was 156 ¡À 92 m); all patients required supplemental oxygen at rest. The St. George's Respiratory Questionnaire (SGRQ) score was 85 ¡À 4.6. Results: At 24?8 h after the procedure, the mean value of FEV1 (from 35 % to 47 % , p < 0.01), FVC (from 42 % to 52 % , p < 0.01), diffusion lung capacity for carbon monoxide (DLCO) (from 31 % to 33 % , p < 0.05) and 6MWT (from 156 m to 281 m, p < 0.01) significantly improved with respect to baseline value. Conversely, mean value of total lung capacity (TLC) (from 157 % to 123 % , p < 0.01) RV (from 231 % to 158 % , p < 0.01) and SGRQ score (from 85 to 37, p < 0.01) was significantly lower than baseline data; these changes were preserved during the entire follow-up. Conclusion: Our preliminary data confirm the feasibility and the potential efficacy of this strategy with significantly immediate improvement of respiration and quality of life, which remains stable during 6 months of follow-up.