TABLE 1.
CLINICIAN'S GUIDE TO LUNG VOLUME REDUCTION SURGERY: SUMMARY
| • Why do you recommend LVRS to a patient? |
| Survival |
| Quality of life |
| Dyspnea relief |
| Improved exercise tolerance |
| • When should I consider LVRS for a patient? |
| Type and severity of patient's symptoms |
| Progressive nature of disease |
| Results of patient's lung function, exercise, and chest CT |
| Patient willingness to undergo comprehensive testing, rehabilitation and major surgery |
| • To whom do you offer LVRS? |
| Upper lobe–predominant emphysema by chest CT |
| Non–upper lobe–predominant emphysema and postrehabilitation low exercise performance |
| • Who should do the preoperative testing to assess LVRS candidacy? |
| Referral physicians obtain lung function, six-minute walk, arterial blood gases, and high-resolution chest CT after pulmonary rehabilitation |
| LVRS center performs maximal exercise test post rehabilitation, echocardiogram, right heart catheterization if Ppa exceeds 45 mm Hg on echocardiogram, preoperative anesthesiology, pulmonary and thoracic surgery evaluations and lung function, six-minute walk, and other preoperative blood work |
| • What are the most important barriers to performing LVRS? |
| Limited awareness by clinicians of the benefits of LVRS or profile of optimal candidates |
| Relegation of LVRS to select centers |
| Limited availability of pulmonary rehabilitation |
| Misperceptions that LVRS is too expensive or screening testing is too exhaustive and complicated |
| • What are the most important questions regarding LVRS that remain unanswered after NETT? |
| Mechanisms of improvement with LVRS |
| Whether patients with heterogeneous but not upper lobe–predominant disease benefit from LVRS |
| If patients with unilateral heterogeneous emphysema benefit from LVRS |
| • What are the major messages delivered by NETT? |
| LVRS is a disease-modifying therapy |
| Clinical phenotype of the patient with COPD is important to assess the natural history of disease and response to therapy |
Definition of abbreviations: COPD = chronic obstructive pulmonary disease; CT = computed tomography; LVRS = lung volume reduction surgery; NETT = National Emphysema Treatment Trial.