Unilateral extrapulmonary airway bypass in advanced emphysema

Ann Thorac Surg. 2010 Mar;89(3):899-906, 906.e1-2. doi: 10.1016/j.athoracsur.2009.10.067.


Background: Gas trapping in emphysema results in resting and dynamic hyperinflation. We tested the hypothesis that a direct connection between the lung parenchyma and the atmosphere could increase expiratory flow and thereby potentially improve dyspnea through the relief of gas trapping.

Methods: Ex vivo we studied 7 emphysematous lungs and 3 fibrotic lungs (as controls) and measured expiratory flow before and after airway bypass insertion during a forced maneuver in an artificial thorax. Pilot studies were conducted in vivo in 6 patients with advanced emphysema using a size 9 endotracheal tube as a bypass surgically placed through the chest wall into the upper lobe.

Results: In the ex vivo emphysematous lungs the volume expelled during a forced expiratory maneuver increased from 169 to 235 mL (p < 0.05). In the in vivo group 4 patients retained the bypass tube for 3 months or more; total lung capacity was reduced, and the forced expiratory volume in 1 second increased by 23% (mean percent predicted at baseline versus 3 months, 24.4% versus 29.5%).

Conclusions: An extrapulmonary airway bypass increases expiratory flow in emphysema. This may be a useful approach in hyperinflated patients with homogeneous emphysema.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Chest Tubes*
  • Dyspnea / etiology
  • Dyspnea / physiopathology
  • Female
  • Forced Expiratory Volume
  • Humans
  • In Vitro Techniques
  • Male
  • Middle Aged
  • Prostheses and Implants*
  • Pulmonary Emphysema / physiopathology
  • Pulmonary Emphysema / surgery*
  • Pulmonary Fibrosis / physiopathology
  • Pulmonary Fibrosis / surgery
  • Pulmonary Ventilation
  • Residual Volume
  • Total Lung Capacity
  • Vital Capacity