EFFECT OF LUNG-VOLUME REDUCTION SURGERY ON PULMONARY HEMODYNAMICS IN SEVERE PULMONARY-EMPHYSEMA

Objective: The presence of pulmonary hypertension in severe pulmonary emphysema has been considered a relative contraindication to lung volu me reduction surgery (LVRS). There was concern that resection of lung tissue might further increase pulmonary artery pressure. To address th is point, the prevalence of pulmonary hypertension in candidates for L VRS was investigated. The changes in pulmonary artery pressures after bilateral videoassisted thoracoscopic resection was studied in patient s with homo- and heterogeneously destroyed emphysematous lungs. Design : The pulmonary arterial pressures by right heart catheterization were prospectively assessed, before and 6 months after LVRS in 21 consecut ive patients (15 males, six females, mean (+/- S.E.) age: 62 +/- 1.9, range 42-74 years). All were former smokers and three had ZZ-ATI defic iency. The inclusion criteria were: (a) severe bronchial obstruction ( FEV1 < 35% predicted); (b) pulmonary hyperinflation (RV/TLC > 0.60); a nd (c) absence of hypercapnia (PaCO2 < 50 mmHg). Results: The FEV1 had increased from 28 +/- 2% to 35 +/- 3% of the predicted value (P < 0.0 5) 6 months after surgery. The RV/TLC had declined from 0.65 +/- 0.02 to 0.55 +/- 0.02; PaO2 increased (66 +/- 1 versus 71 +/- 2 mmHg, P = 0 .04), PaCO2 (38 +/- 2 versus 36 +/- 1 mmHg, P = 0.26) did not change. The pulmonary artery mean pressure (PAP(mean)) remained unchanged (18 +/- 1 versus 19 +/- 1 mmHg, P = 0.26). In six patients PAP(mean) was g reater than or equal to 20 mmHg (up to 24 mmHg) preoperatively. After 6 months, six patients had a PAP(mean) greater than or equal to 20 mmH g (up to 31 mmHg). Conclusions: In patients with severe emphysema who are candidates for LVRS (but have only mild to moderate hypoxemia and a PaCO2 < 50 mmHg) we found no relevant pulmonary hypertension and pul monary artery pressure did not change significantly after surgery. The refore, routine right heart catheterization is not mandatory for preop erative evaluation. (C) 1998 Elsevier Science B.V. All rights reserved .