EXTENDED INDICATIONS FOR LUNG-VOLUME REDUCTION SURGERY IN ADVANCED EMPHYSEMA

Background. Lung volume reduction surgery has shown early promise as a palliative therapy in severe emphysema. Selection of potential candid ates has been based on certain functional and anatomic criteria, and a variety of operative contraindications have been proposed. Methods. O ver 15 months, we performed lung volume reduction surgery in 85 patien ts selected on the basis of severe hyperinflation with air trapping di aphragmatic dysfunction, and disease heterogeneity. Patients were not excluded on the basis of severe hypercapnia, steroid dependence, profo und pulmonary dysfunction, or inability to complete preoperative rehab ilitation. Results. We observed significant improvements in pulmonary function, exercise capacity, and dyspnea, with an acceptable 30-day pe rioperative mortality of 7% and actuarial survival of 90% and 83% at 6 and 12 months, respectively. In each ''high-risk'' group, perioperati ve mortality, actuarial survival to I year, and functional results wer e equivalent, and in some cases superior, to those in the correspondin g ''low-risk'' patients. Conclusions. Severe hypercapnia, steroid depe ndence, profound pulmonary dysfunction, and inability to complete preo perative rehabilitation do not preclude successful lung volume reducti on surgery and should not be regarded as absolute exclusionary criteri a.