Alfonso Fiorelli1, Antonio D'Andrilli2, Marco Anile3, Daniele Diso3, Camilla Poggi2, Mario Polverino4, Giuseppe Failla5, Federico Venuta3, Erino Angelo Rendina2, Mario Santini6. 1. Division of Thoracic Surgery Unit, Faculty of Medicine, Second University of Naples, Naples, Italy. Electronic address: alfonso.fiorelli@unina2.it. 2. Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy. 3. Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Medicine and Pharmacy, University of Rome "Sapienza," Rome, Italy. 4. Pneumology and Rehabilitation Unit, Mauro Scarlato Hospital, Scafati, Italy. 5. Endoscopic Air-Way Unit, ARNAS-Ospedale Civico Di Cristina Benfratelli, Palermo, Italy. 6. Division of Thoracic Surgery Unit, Faculty of Medicine, Second University of Naples, Naples, Italy.
Abstract
BACKGROUND: Clinical benefits of bronchoscopic lung volume reduction with one-way endobronchial valves have been reported for heterogeneous emphysema after unilateral treatment. We assessed the potential role of contralateral treatment to prolong the benefits obtained with the first procedure. METHODS: This was a retrospective multicenter study including consecutive patients with heterogeneous emphysema undergoing bronchoscopic valves deployment during the last 4 years. Patients were split into two groups depending on the procedure (unilateral versus bilateral). The intergroup differences were evaluated to assess the viability, effectiveness, and safety of the bilateral procedure. RESULTS: Forty-nine patients were enrolled. Of these, 14 (28%) had a sequential bilateral procedure mainly due to loss of the clinical benefits obtained with the first treatment. A significant improvement of forced expiratory volume in 1 second (p < 0.05), forced vital capacity (p < 0.05), residual volume (p < 0.05), 6-minute walking test (p < 0.05), and St. George respiratory questionnaire (p < 0.02) was achieved after the second procedure. These results were maintained during follow-up. There was no significant difference regarding the changes of forced expiratory volume in 1 second (p = 0.4), forced vital capacity (p = 0.08), residual volume (p = 0.9), 6-minute walking test (p = 0.3), and St. George respiratory questionnaire (p = 0.1) between the bilateral and unilateral groups. CONCLUSIONS: A sequential bilateral approach seems to be a valid strategy to improve respiratory function in patients with bilateral heterogeneous emphysema who have lost the benefits obtained with the first procedure.
BACKGROUND: Clinical benefits of bronchoscopic lung volume reduction with one-way endobronchial valves have been reported for heterogeneous emphysema after unilateral treatment. We assessed the potential role of contralateral treatment to prolong the benefits obtained with the first procedure. METHODS: This was a retrospective multicenter study including consecutive patients with heterogeneous emphysema undergoing bronchoscopic valves deployment during the last 4 years. Patients were split into two groups depending on the procedure (unilateral versus bilateral). The intergroup differences were evaluated to assess the viability, effectiveness, and safety of the bilateral procedure. RESULTS: Forty-nine patients were enrolled. Of these, 14 (28%) had a sequential bilateral procedure mainly due to loss of the clinical benefits obtained with the first treatment. A significant improvement of forced expiratory volume in 1 second (p < 0.05), forced vital capacity (p < 0.05), residual volume (p < 0.05), 6-minute walking test (p < 0.05), and St. George respiratory questionnaire (p < 0.02) was achieved after the second procedure. These results were maintained during follow-up. There was no significant difference regarding the changes of forced expiratory volume in 1 second (p = 0.4), forced vital capacity (p = 0.08), residual volume (p = 0.9), 6-minute walking test (p = 0.3), and St. George respiratory questionnaire (p = 0.1) between the bilateral and unilateral groups. CONCLUSIONS: A sequential bilateral approach seems to be a valid strategy to improve respiratory function in patients with bilateral heterogeneous emphysema who have lost the benefits obtained with the first procedure.
Authors: Alfonso Fiorelli; Carlo Santoriello; Alberto De Felice; Francesco Ferrigno; Annalisa Carlucci; Emanuele De Ruberto; Rossella Mastromarino; Lisa Occhiati; Gaetana Messina; Elena Santoriello; Giovanni Vicidomini; Mario Polverino; Mario Santini Journal: J Vis Surg Date: 2017-11-17
Authors: Alfonso Fiorelli; Antonio D'Andrilli; Roberto Cascone; Luisa Occhiati; Marco Anile; Daniele Diso; Francesco Cassiano; Camilla Poggi; Mohsen Ibrahim; Giacomo Cusumano; Alberto Terminella; Giuseppe Failla; Alba La Sala; Michela Bezzi; Margherita Innocenti; Elena Torricelli; Federico Venuta; Erino Angelo Rendina; Giovanni Vicidomini; Mario Santini; Claudio Andreetti Journal: J Thorac Dis Date: 2018-11 Impact factor: 2.895