Effect of lung volume reduction surgery on resting pulmonary hemodynamics in severe emphysema.
BACKGROUND
To determine the effect of medical treatment versus lung volume reduction surgery (LVRS) on pulmonary hemodynamics.


METHODS
Three clinical centers of the National Emphysema Treatment Trial (NETT) screened patients for additional inclusion into a cardiovascular (CV) substudy. Demographics were determined, and lung function testing, six-minute-walk distance, and maximum cardiopulmonary exercise testing were done at baseline and 6 months after medical therapy or LVRS. CV substudy patients underwent right heart catheterization at rest prerandomization (baseline) and 6 months after treatment.


RESULTS
A total of 110 of the 163 patients evaluated for the CV substudy were randomized in NETT (53 were ineligible), 54 to medical treatment and 56 to LVRS. Fifty-five of these patients had both baseline and repeat right heart catheterization 6 months postrandomization. Baseline demographics and lung function data revealed CV substudy patients to be similar to the remaining 1,163 randomized NETT patients in terms of age, sex, FEV(1), residual volume, diffusion capacity of carbon monoxide, Pa(O(2)), Pa(CO(2)), and six-minute-walk distance. CV substudy patients had moderate pulmonary hypertension at rest (Ppa, 24.8 +/- 4.9 mm Hg); baseline hemodynamic measurements were similar across groups. Changes from baseline pressures to 6 months post-treatment were similar across treatment groups, except for a smaller change in pulmonary capillary wedge pressure at end-expiration post-LVRS compared with medical treatment (-1.8 vs. 3.5 mm Hg, p = 0.04).


CONCLUSIONS
In comparison to medical therapy, LVRS was not associated with an increase in pulmonary artery pressures.
Criner
Gerard J
GJ
Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA. crinerg@tuhs.temple.edu
Scharf
Steven M
SM
Falk
Jeremy A
JA
Gaughan
John P
JP
Sternberg
Alice L
AL
Patel
Namrata B
NB
Fessler
Henry E
HE
Minai
Omar A
OA
Fishman
Alfred P
AP
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D006328:Cardiac Catheterization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011651:Pulmonary Artery / Q000502:physiology*; D011656:Pulmonary Emphysema / Q000188:drug therapy* / Q000601:surgery*; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D014109:Total Lung Capacity / Q000502:physiology*