PS59. Lung Volume Reduction Surgery is Safe and Improves Quality of Life in Patients Who Are Not Candidates for Bronchoscopic Lung Volume Reduction

Los Angeles Convention Center 

Objective: Lung volume reduction surgery (LVRS) has been shown to improve exercise capacity and survival in patients with upper lobe predominant emphysema. Bronchoscopic lung volume reduction (BLVR) has supplanted surgery, with LVRS often being reserved for patients who are either not candidates for or who have failed BLVR. Our study aims to investigate the outcomes of LVRS among patients who either failed BLVR or were not candidates for it.
Methods: We conducted a retrospective analysis of patients who underwent LVRS for upper lobe predominant emphysema in a single tertiary center between March 2018 and June 2022. The main outcomes measured were pre- and post-operative respiratory parameters, peri-operative morbidity and mortality.
Results: A total of 50 LVRS were performed, of which 10 had prior failed valve placement. The rest were found to have collateral flow on bronchoscopy (n=11) or had preoperative imaging that demonstrated fissure integrity (n=29) precluding BLVR. The mean age of patients was 68 ± 6, and 22 (44%) were female. The mean pre-operative FEV1 was 0.85 L ± 0.27, DLCO 34.2% ± 9.3 and VO2 max of 10.5 ± 2.4 (peak, ml/kg/min). All procedures were performed thoracoscopically (VATS), with 30 patients (60%) undergoing bilateral LVRS. Average specimen weight was 63 g for right sided procedures, and 67 g for the left. Post operatively, only 2 patients remained intubated, and 14 (28%) patients required ICU admission. The median length of hospital stay was 8 days (IQR=6). Prolonged air leak (>7 days) occurred in 20 (40%) patients, of which 3 required successful surgical re-exploration via VATS; 13 patients (26%) were discharged home with a Heimlich valve. Other complications included DVT/PE (n=2), pneumonia (n=4), re-intubation (n=4). There was only one 90-day mortality from a nosocomial pneumonia (non-Covid related). Mean parameter improvements were as follows: FEV1 38.3% from 31% (p=0.01), DLCO 39.2% from 34.2% (p=0.07), and residual volume 3.3 L from 4.6 (p<0.01). On the 6-minute walk test, traveled distance increased to 272 m from 254 (p=0.3) and the reported dyspnea improved from 4.9 to 2.9 (p=0.03).
Conclusion: LVRS can be safely performed in patients who are either not candidates for BLVR or those who did not respond favorably. It is associated with acceptable morbidity, low mortality, and significant functional improvement. LVRS remains an important tool in the treatment of patients with upper lobe predominant emphysema.

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