Lung Volume Reduction Surgery as a Bridge to Lung Transplantation
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Am J Respir Med 2002; 1 (5): 313-324 1175-6365/02/0005-0313/$25.00/0 © Adis International Limited. All rights reserved.
Lung Volume Reduction Surgery as a Bridge to Lung Transplantation Francis C. Cordova and Gerard J. Criner Temple University School of Medicine, Philadelphia, Pennsylvania, USA
Abstract
Lung volume reduction surgery (LVRS) improves lung function, exercise capacity, and quality of life in patients with advanced emphysema. In some patients with emphysema who are candidates for lung transplantation, LVRS is an alternative treatment option to lung transplantation, or may be used as a bridge to lung transplantation. Generally accepted criteria for LVRS include severe non-reversible airflow obstruction due to emphysema associated with significant evidence of lung hyperinflation and air trapping. Both high resolution computed tomography (CT) scan of the chest and quantitative ventilation/perfusion scan are used to identify lung regions with severe emphysema which would be used as targets for lung resection. Bilateral LVRS is the preferred surgical approach compared with the unilateral procedure because of better functional outcome. Lung transplantation is the preferred surgical treatment in patients with emphysema with α1 antitrypsin deficiency and in patients with very severe disease who have homogeneous emphysema pattern on CT scan of the chest or very low diffusion capacity.
Chronic obstructive pulmonary disease (COPD) due to emphysema is a progressive disease characterized by the destruction of the alveolar-capillary exchange units. It has been estimated that approximately 2 million individuals have emphysema.[1] Patients with moderate to severe emphysema typically experience exertional dyspnea, cough, and a gradual but progressive decline in exercise capacity. Over the past several decades, despite significant advances in the care of patients with COPD, it remains a major cause of morbidity and mortality worldwide. For the majority of patients with mild to moderate emphysema, comprehensive medical management in conjunction with pulmonary rehabilitation, is often adequate to control symptoms, and to maximize exercise capacity.[1] However, for patients with advanced emphysema, standard medical therapy is often unsatisfactory. Until the reintroduction of lung volume reduction surgery (LVRS) by Cooper and colleagues,[2] lung transplantation was the only surgical treatment option available for patients with emphysema who remained symptomatic despite optimal medical care. Because some patients with advanced emphysema who are being evaluated for lung transplantation also fulfill the criteria for LVRS, and because of the scarcity of available donor lungs, LVRS has been
suggested by some authors to serve as a bridge to lung transplantation.[3,4] Since the reintroduction of LVRS 8 years ago, more is known regarding its short-term, and long-term effects on lung function and exercise performance. This review summarizes the most recent data regarding the short- and long-term outcomes of LVRS, the most curren
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