Bronchoscopic lung volume reduction as a bridge to lung transplantation in patients with chronic obstructive pulmonary disease

Venuta, Federico; Diso, Daniele; Anile, Marco; De Giacomo, Tiziano; Rendina, Erino A.; Rolla, Matilde; Ricella, Chiara; Coloni, Giorgio F.
March 2011
European Journal of Cardio-Thoracic Surgery;Mar2011, Vol. 39 Issue 3, p364
Academic Journal
Abstract: Background: Chronic obstructive pulmonary disease (COPD) is the leading indication for lung transplantation; however, these patients rarely gain priority on the waiting list until very late. The clinical status can be improved by surgical lung volume reduction; this procedure, although carries significant morbidity, has been repeatedly advocated as a bridge. Recently, bronchoscopic lung volume reduction (BLVR) has been proposed to improve functional parameters in patients with emphysema; however, it has never been reported as a bridge to lung transplantation so far. Methods: We hereby report our experience with BLVR as a bridge to lung transplantation in four patients (males, mean age 51 years). Results: All patients underwent unilateral BLVR (two right upper lobe (RUL), one right lower lobe (RLL), and one left upper lobe (LUL); mean 3.5 valves per patient). No morbidity and mortality were observed. Three out of the four patients successfully reached transplantation after 6, 7, and 6 months, respectively. Two patients received single-lung transplantation and one sequential double-lung transplantation. The fourth patient died of respiratory failure 13 months after valve placement. BLVR was able to reduce the residual volume and improve the 6-min walking test and Medical Research Council (MRC) score. Conclusions: BLVR allowed to improve the functional status and quality of life of these patients. In a selected group of COPD patients awaiting lung transplantation, the reported short- to medium-term objective improvement may play an important role to ameliorate the clinical status and reach the time of surgery.


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