TY - JOUR
T1 - Pulmonary Hypertension
T2 - A Contraindication for Lung Volume Reduction Surgery?
AU - Thuppal, Sowmyanarayanan
AU - Crabtree, Traves
AU - Markwell, Stephen
AU - Colle, Joni
AU - Boley, Theresa
AU - Manning, Blaine
AU - Nallamothu, Nasaraiah
AU - Hazelrigg, Stephen
N1 - Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/3
Y1 - 2020/3
N2 - Background: Historically, pulmonary hypertension (PH) has been considered as one of the contraindications for lung volume reduction surgery (LVRS). Newer studies have shown that LVRS is successful in select emphysema patients with PH. Methods: In-hospital and 1-year functional and quality of life (QOL) outcomes were studied in patients with PH post-LVRS. PH was defined as pulmonary artery pressure (PAP) exceeding 35 mm Hg by right heart catheterization (RHC), where available, or else exceeding 35 mm Hg by echocardiogram. Results: Of 124 patients who underwent LVRS, 56 (45%) had PH (mean PAP, 41 mm Hg) with 48 mild to moderate and 8 severe PH. In-hospital outcomes were similar between patients with and without PH: hours of artificial ventilation (1.8 vs 0.06, P =.882), days in intensive care (4 vs 6, P =.263), prolonged air leak (12% vs 19%, P =.402), and days of hospital stay (13 vs 16, P =.072). Lung function improved significantly at the 1-year follow-up in patients with PH: forced expiratory volume in 1 second % predicted (26 vs 38, P =.001), forced vital capacity % (62 vs 90, P =.001), residual volume % predicted (224 vs 174, P =.001), diffusion capacity of the lung for carbon monoxide % predicted (36 vs 43, P =.001), 6-minute walk distance test (1104 vs 1232 feet, P =.001), and QOL utility scores (0.67 vs 0.77, P =.001). There were no differences in in-hospital, baseline, and follow-up functional and QOL outcomes between patients with and without PH. Conclusions: In this small, single-institution cohort, outcomes of patients undergoing LVRS for emphysema with PH were similar to those of patients without PH. LVRS may be a potential option for select emphysema patients with PH.
AB - Background: Historically, pulmonary hypertension (PH) has been considered as one of the contraindications for lung volume reduction surgery (LVRS). Newer studies have shown that LVRS is successful in select emphysema patients with PH. Methods: In-hospital and 1-year functional and quality of life (QOL) outcomes were studied in patients with PH post-LVRS. PH was defined as pulmonary artery pressure (PAP) exceeding 35 mm Hg by right heart catheterization (RHC), where available, or else exceeding 35 mm Hg by echocardiogram. Results: Of 124 patients who underwent LVRS, 56 (45%) had PH (mean PAP, 41 mm Hg) with 48 mild to moderate and 8 severe PH. In-hospital outcomes were similar between patients with and without PH: hours of artificial ventilation (1.8 vs 0.06, P =.882), days in intensive care (4 vs 6, P =.263), prolonged air leak (12% vs 19%, P =.402), and days of hospital stay (13 vs 16, P =.072). Lung function improved significantly at the 1-year follow-up in patients with PH: forced expiratory volume in 1 second % predicted (26 vs 38, P =.001), forced vital capacity % (62 vs 90, P =.001), residual volume % predicted (224 vs 174, P =.001), diffusion capacity of the lung for carbon monoxide % predicted (36 vs 43, P =.001), 6-minute walk distance test (1104 vs 1232 feet, P =.001), and QOL utility scores (0.67 vs 0.77, P =.001). There were no differences in in-hospital, baseline, and follow-up functional and QOL outcomes between patients with and without PH. Conclusions: In this small, single-institution cohort, outcomes of patients undergoing LVRS for emphysema with PH were similar to those of patients without PH. LVRS may be a potential option for select emphysema patients with PH.
UR - http://www.scopus.com/inward/record.url?scp=85078801549&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85078801549&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2019.09.023
DO - 10.1016/j.athoracsur.2019.09.023
M3 - Article
C2 - 31610165
AN - SCOPUS:85078801549
SN - 0003-4975
VL - 109
SP - 902
EP - 906
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -