Lung volume reduction surgery using the NETT selection criteria

Mark E. Ginsburg, Byron M. Thomashow, Chun K. Yip, Angela M. Dimango, Roger A. Maxfield, Matthew N. Bartels, Patricia Jellen, William A. Bulman, David Lederer, Francis L. Brogan, Lyall A. Gorenstein, Joshua R. Sonett

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: The National Emphysema Treatment Trial (NETT) proved that lung volume reduction surgery (LVRS) was safe and effective in patients with certain clinical characteristics and using defined inclusion-exclusion criteria. Based on the selection criteria developed in that trial, we performed bilateral LVRS on 49 patients during the period of February 2004 until May 2009. Methods: Forty-nine patients underwent lung volume reduction by either median sternotomy (10) or video-assisted thoracoscopic surgery (39) selected according to NETT described parameters. Preoperative characteristics were the following: mean (±SD) age 62.5 ± 6.6 years, preoperative FEV1 (forced expiratory volume in the first second of expiration) 691 cc (± 159), % of predicted FEV1 25.3 (± 6.2), preoperative Dlco (diffusing capacity of lung for carbon monoxide) 7.6 (± 2.7), and % of predicted DLCO 27% (± 7.3). All patients had upper lobe predominant disease and either low exercise capacity (n = 23) or high exercise capacity (n = 26) as defined by the NETT. Results: There was no operative or 90-day mortality. Median length of stay was 8 days (interquartile range = 6 to 10). Two patients required reintubation and tracheostomy but were decannulated prior to discharge. The BODE index (body mass index, airflow obstruction, dyspnea, and exercise capacity), a multidimensional predictor of survival in chronic obstructive pulmonary disease, improved -2.3 (± 1.5, p < 0.0001) (missing data: 5 of 42, 11.9%) and the FEV1 improved 286 cc (± 221, p < 0.0001), both 1 year after surgery. Probability of survival was 0.98 (95% CI [confidence interval] = 0.94 to 1) at 1 year, and 0.95 (95% CI = 0.88 to 1) at 3 years. Conclusions: Surgical lung volume reduction for emphysema can be performed in patients using selection criteria developed by the NETT with very low surgical risk and excellent midterm results. Surgical LVRS is the standard against which other nonsurgical treatments for advanced emphysema should be judged.

Original languageEnglish (US)
Pages (from-to)1556-1561
Number of pages6
JournalAnnals of Thoracic Surgery
Volume91
Issue number5
DOIs
StatePublished - May 2011
Externally publishedYes

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Pneumonectomy
Emphysema
Patient Selection
Exercise
Therapeutics
Confidence Intervals
Lung Volume Measurements
Video-Assisted Thoracic Surgery
Sternotomy
Survival
Tracheostomy
Forced Expiratory Volume
Carbon Monoxide
Dyspnea
Chronic Obstructive Pulmonary Disease
Length of Stay
Body Mass Index
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Ginsburg, M. E., Thomashow, B. M., Yip, C. K., Dimango, A. M., Maxfield, R. A., Bartels, M. N., ... Sonett, J. R. (2011). Lung volume reduction surgery using the NETT selection criteria. Annals of Thoracic Surgery, 91(5), 1556-1561. https://doi.org/10.1016/j.athoracsur.2011.01.054

Lung volume reduction surgery using the NETT selection criteria. / Ginsburg, Mark E.; Thomashow, Byron M.; Yip, Chun K.; Dimango, Angela M.; Maxfield, Roger A.; Bartels, Matthew N.; Jellen, Patricia; Bulman, William A.; Lederer, David; Brogan, Francis L.; Gorenstein, Lyall A.; Sonett, Joshua R.

In: Annals of Thoracic Surgery, Vol. 91, No. 5, 05.2011, p. 1556-1561.

Research output: Contribution to journalArticle

Ginsburg, ME, Thomashow, BM, Yip, CK, Dimango, AM, Maxfield, RA, Bartels, MN, Jellen, P, Bulman, WA, Lederer, D, Brogan, FL, Gorenstein, LA & Sonett, JR 2011, 'Lung volume reduction surgery using the NETT selection criteria', Annals of Thoracic Surgery, vol. 91, no. 5, pp. 1556-1561. https://doi.org/10.1016/j.athoracsur.2011.01.054
Ginsburg, Mark E. ; Thomashow, Byron M. ; Yip, Chun K. ; Dimango, Angela M. ; Maxfield, Roger A. ; Bartels, Matthew N. ; Jellen, Patricia ; Bulman, William A. ; Lederer, David ; Brogan, Francis L. ; Gorenstein, Lyall A. ; Sonett, Joshua R. / Lung volume reduction surgery using the NETT selection criteria. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 5. pp. 1556-1561.
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author = "Ginsburg, {Mark E.} and Thomashow, {Byron M.} and Yip, {Chun K.} and Dimango, {Angela M.} and Maxfield, {Roger A.} and Bartels, {Matthew N.} and Patricia Jellen and Bulman, {William A.} and David Lederer and Brogan, {Francis L.} and Gorenstein, {Lyall A.} and Sonett, {Joshua R.}",
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AU - Thomashow, Byron M.

AU - Yip, Chun K.

AU - Dimango, Angela M.

AU - Maxfield, Roger A.

AU - Bartels, Matthew N.

AU - Jellen, Patricia

AU - Bulman, William A.

AU - Lederer, David

AU - Brogan, Francis L.

AU - Gorenstein, Lyall A.

AU - Sonett, Joshua R.

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N2 - Background: The National Emphysema Treatment Trial (NETT) proved that lung volume reduction surgery (LVRS) was safe and effective in patients with certain clinical characteristics and using defined inclusion-exclusion criteria. Based on the selection criteria developed in that trial, we performed bilateral LVRS on 49 patients during the period of February 2004 until May 2009. Methods: Forty-nine patients underwent lung volume reduction by either median sternotomy (10) or video-assisted thoracoscopic surgery (39) selected according to NETT described parameters. Preoperative characteristics were the following: mean (±SD) age 62.5 ± 6.6 years, preoperative FEV1 (forced expiratory volume in the first second of expiration) 691 cc (± 159), % of predicted FEV1 25.3 (± 6.2), preoperative Dlco (diffusing capacity of lung for carbon monoxide) 7.6 (± 2.7), and % of predicted DLCO 27% (± 7.3). All patients had upper lobe predominant disease and either low exercise capacity (n = 23) or high exercise capacity (n = 26) as defined by the NETT. Results: There was no operative or 90-day mortality. Median length of stay was 8 days (interquartile range = 6 to 10). Two patients required reintubation and tracheostomy but were decannulated prior to discharge. The BODE index (body mass index, airflow obstruction, dyspnea, and exercise capacity), a multidimensional predictor of survival in chronic obstructive pulmonary disease, improved -2.3 (± 1.5, p < 0.0001) (missing data: 5 of 42, 11.9%) and the FEV1 improved 286 cc (± 221, p < 0.0001), both 1 year after surgery. Probability of survival was 0.98 (95% CI [confidence interval] = 0.94 to 1) at 1 year, and 0.95 (95% CI = 0.88 to 1) at 3 years. Conclusions: Surgical lung volume reduction for emphysema can be performed in patients using selection criteria developed by the NETT with very low surgical risk and excellent midterm results. Surgical LVRS is the standard against which other nonsurgical treatments for advanced emphysema should be judged.

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