Comparison of Changes in Hemodynamics between Unilateral and Bilateral Lung Volume Reduction for Pulmonary Emphysema
Kiyoshi Koizumi, MD,1 Shuji Haraguchi, MD,1 Hirohiko Akiyama, MD,2 Tomomi Hirata, MD,1 Kyoji Hirai, MD,1 Iwao Mikami, MD,1 and Shigeo Tanaka, MD1
This study was aimed to compare changes in hemodynamics between unilateral (UL) or simultaneous bilateral (BL) lung volume reduction surgery (LVRS) for chronic obstructive lung disease. Sixteen patients underwent LVRS by stapler resection with neodymium: yttrium-alminum-garnet (Nd: YAG) laser ablation; five underwent BL-LVRS (four by median sternotomy and one by thoracoscopy) and 11 underwent UL-LVRS by thoracoscopy. Four patients had multiple bullae within pulmonary emphysema. At preoperation and 6, 12, 24, and 48 hours postoperatively, hemodynamics and right ventricular performance were evaluated. UL- and BL-LVRS reduced afterload of the right and left ventricle postoperatively. Although the pulmonary arterial resistance increased after surgery, the total pulmonary resistance decreased (p=0.001) in association with the reduced systemic vascular resistance (p=0.001). These reductions improved cardiopulmonary circulation, resulting in increased stroke volume and cardiac output (p=0.003). The right ventricular ejection fraction showed minimal change 48 hours postoperation. Two patients died of pneumonia caused by persistent air leakage. In conclusion, both the UL- and BL-LVRS showed similar effectiveness in terms of improvement in the systemic and cardiopulmonary circulation after LVRS, if there were no postoperative complications. We concluded that we had to reduce and repair the persistent air leakage after LVRS. (Ann Thorac Cardiovasc Surg 2001; 7: 266-272)
Key words: pulmonary emphysema, lung volume reduction, hemodynamics, right ventricular ejection fraction
From the 1Department of Surgery II, Nippon Medical School, Tokyo, and 2Department of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan.
Received February 1, 2001; accepted for publication March 9, 2001
Address reprint requests to Kiyoshi Koizumi, MD: Department of Surgery II, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.