An Animal Model for Lung Volume Reduction Therapy of Pulmonary Emphysema

John C. Chen Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Matthew Brenner Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Fernando E. Kafie Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Benedid Yoong Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Michael Budd Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Adam Gassel Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Teri A. Waite Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Jeff Millikan Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Joe Huh Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Nai-San Wang Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Robert McKenna Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

A. Gelb Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Archie F. Wilson Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

Michael W. Berns Pulmonary and Critical Care Medicine Division, Departments of Surgery, and Pathology, University of California Irvine Medical Center, Orange, California, USA; Beckman Laser Institute and Medical Clinic, Irvine, California, USA; Chapman Medical Center, Orange, California, USA

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Abstract

Stapled lung volume reduction surgery (LVRS) has recently been described for treatment of emphysema. Many questions arise regarding physiologic mechanisms of response from surgical treatment of emphysema. The objective of this study was to develop an animal model for the study of lung volume reduction surgery in diffuse heterogeneous emphysema. We hypothesized that elastic recoil would increase, static respiratory system compliance would decrease, and expiratory flows would increase after lung volume reduction surgery in animals with emphysema. In the study, emphysema was induced in 31 New Zealand White rabbits (3-5 kg) with endotracheally aerosalized porcine elastase (10,000-12,000 U). Lateral thoracotomies were performed 4-6 weeks postinduction under general anesthesia and mechanical ventilatory support. Stapled volume reduction was performed on the right lower lobe using a standard multirow pediatric stapler (U.S. Surgical). Pulmonary function tests were performed at baseline (preinduc-tion), before stapling LVRS (postemphysema induction), immediately post stapling LVRS, and 1 week poststapling. Static respiratory system compliance, flow, conductance and forced expiratory flows, and peak flows at 20 and 40 cm³ of exhaled volume were analyzed. Animals were sacrificed 1 week poststapling, and bilateral lungs were harvested for histopathology. Diffuse but heterogeneous pulmonary emphysema was seen in these animals treated with high-dose aerosolized elastase. Static compliance increased, while expiratory flows and conductance decreased after induction of emphysema. Immediately post stapled volume reduction therapy, animals had decreased static compliance. By 1 week following surgery, animals showed increased forced expiratory flows and decreased expiratory resistance, although compliance was similar to preoperative levels. In conclusion, we describe initial results in an animal model of obstructive emphysema suitable for the study of lung volume reduction surgery. Changes in pulmonary function indicate that unilateral lower lobe LVRS increases airway conductance in the rabbits. Findings from LVRS studies in animal models such as this may help explain clinical improvement following LVRS in humans.

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An Animal Model for Lung Volume Reduction Therapy of Pulmonary Emphysema

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An Animal Model for Lung Volume Reduction Therapy of Pulmonary Emphysema

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