Telephone Number

310-825-8061 (Information and referral)

Medical Director

Christopher B. Cooper, M.D.

LUNG VOLUME REDUCTION SURGERY
Lung volume reduction surgery (LVRS) is considered appropriate for selected patients with predominantly upper lobe emphysema and low exercise capacity. Results from the National Emphysema Treatment Trial (NETT) published in the New England Journal of Medicine [LINKS] demonstrated that 10% of patients derive an increase in maximum work performance of 10 watts. UCLA Medical Center was involved in the development of the NETT protocol and participated in the early stages of the study. Commencing January 1, 2004 UCLA Medical Center will be one of 16 centers in the country approved by Medicare to offer this surgery. The approved approach to LVRS is bilateral excision of diseased lung with stapling performed via median sternotomy or video-assisted thoracoscopic surgery. The COPD Center welcomes patient referrals for LVRS evaluation. The specific inclusion criteria are as follows:

· History and physical examination consistent with emphysema
· HRCT evidence of bilateral emphysema
· Forced expiratory volume in one second (FEV1) <45% predicted (and >15% predicted if age >70 years)
· Total lung capacity (TLC) >100% predicted, post-bronchodilator
· Residual volume (RV) >150% predicted, post-bronchodilator
· PaCO2 <60 mm Hg breathing room air at sea level
· PaO2 >45 mm Hg breathing room air at sea level
· Post-rehabilitation 6-minute walking distance >140 m
· Able to complete 3 minutes of unloaded pedaling on cycle ergometer
· Non-smoking for 4 months

Patients are required to have preoperative approval by a pulmonary specialist, thoracic surgeon and anesthesiologist. They must also have cardiac assessment and measurement of exercise capacity. They are required by Medicare to complete a program of pulmonary rehabilitation including specified services that are arranged, monitored and performed under the coordination of the facility where surgery takes place.