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* From the Department of Internal Medicine (Drs. Flaherty and Martinez), Division of Pulmonary and Critical Care Medicine, the Department of Radiology (Dr. Kazerooni), Chest Division, and the Department of Surgery (Dr. Iannettoni), Division of Cardiothoracic Surgery, University of Michigan Health System; the Department of Biostatistics (Drs. Lange and Schork), University of Michigan School of Public Health; and the Medical Service (Dr. Curtis), Pulmonary and Critical Care Medicine Section, Department of Veterans Affairs Medical Center, Ann Arbor, MI.
Correspondence to: Fernando J. Martinez, MD, Division of Pulmonary and Critical Care Medicine, 3916 Taubman Center, Box 0360, 1500 E Medical Center Dr, University of Michigan Medical Center, Ann Arbor, MI 48109-0360; e-mail: fmartine{at}umich.edu
Objectives: To evaluate selection criteria and duration of benefit for patients undergoing lung volume reduction surgery (LVRS).
Methods: Eighty-nine consecutive patients with severe emphysema who underwent bilateral LVRS were prospectively followed up for up to 3 years. Patients underwent preoperative pulmonary function testing, 6-min walk, chest CT, and answered a baseline dyspnea questionnaire. CT scans in 65 patients were analyzed for emphysema extent and distribution using the percentage of emphysema in the lung, percentage of normal lower lung, and the CT emphysema ratio (CTR, an index of the craniocaudal distribution of emphysema). All patients underwent at least 6 weeks of pulmonary rehabilitation prior to surgery. Outcome measures were FEV1, 6-min walk distance, and transitional dyspnea index (TDI).
Results: Compared to baseline, FEV1
was significantly increased at 3, 6, 12, 18, 24, and 36 months after
surgery (p 
0.008). The 6-min walk distance increased from 871 feet
(baseline) to 1,110 feet (3 months), 1,214 feet (6 months), 1,326 feet
(12 months), 1,342 feet (18 months), 1,371 feet (24 months), and 1,390
feet (36 months) after surgery. Despite a decline in FEV1
over time, 6-min walk distance was preserved. Dyspnea as measured by
TDI improved at 3, 6, 12, 18, 24, and 36 months after surgery. A high
CTR was the best predictor of a 12% increase over baseline and an
absolute increase of 200 mL in FEV1, although with a low
area under the receiver operating characteristic curve. In addition,
the sensitivity and negative predictive value of the CTR were limited.
No radiographic or physiologic predictor was able to consistently
predict a successful increase in walk distance or TDI.
Conclusion: LVRS improves pulmonary function, decreases dyspnea, and enhances exercise capacity in many patients with severe emphysema, although improvement wanes 36 months after surgery.
Key Words: CT • emphysema • exercise capacity • lung volume reduction
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