Functional results of unilateral lung volume reduction surgery in alpha1-antitrypsin deficient patients

Gaëlle Dauriat¹, Hervé Mal¹, Gilles Jebrak¹, Olivier Brugière¹, Yves Castier², Juliette Camuset¹, Armelle Marceau¹, Camille Taillé¹, Guy Lesèche², Michel Fournier¹

¹Department of Pneumology and ²Department of Vascular and Thoracic Surgery, Hôpital Beaujon, Clichy, France

Abstract: Lung volume reduction surgery (LVRS) has been shown to improve lung function and exercise tolerance in patients with severe emphysema. Some predictors of poor outcome have been described but the role of alpha₁-antitrypsin (α₁-AT) deficiency is still not well known. The aim of this study was to analyze the results of unilateral LVRS in our center according to the α₁-AT status. The results of LVRS in 17 deficient patients and 35 nondeficient patients were analyzed at 3-6 months and 1 year after surgery. Compared with baseline, a significant improvement of FEV₁, partial pressure in arterial blood (PaO₂), dyspnea score and walking distance was observed in the two groups at 3-6 months after surgery and the studied parameters remained significantly improved at 1 year in the nondeficient group. By contrast, PaO₂ and walking distance returned towards baseline in the deficient group at 1 year whereas improvement of FEV₁ and dyspnea score was persistent. Mean values of FEV₁ at baseline, 3-6 months, and 1 year were 22± 6%, 29 ± 11%, and 26 ± 9% and 28 ± 12%, 38 ± 17%, and 40 ± 17% predicted in the deficient group and in the non-deficient group, respectively. In conclusion, the functional benefit is short-lasting in α₁-AT deficient patients after unilateral LVRS.

Keywords: alpha₁-antitrypsin deficiency, lung volume reduction surgery, emphysema