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Lung Volume Reduction Surgery
WHAT IS LVRS? In 1997, the University of California, San Diego Medical Center was awarded a National Institutes of Health (NIH) grant to become of the the 17 centers of excellence in the National Emphysema Treatment Trial (NETT). This national clinical trial was designed to determine what is the best treatment for people with severe emphysema: medical management alone, which typically involves medication and rehabilitation or medical management plus Lung Volume Reduction Surgery (LVRS), in which damaged portions of each lung are removed. The results of the NETT Study indicate that, on average, patients who undergo LVRS with medical therapy are more likely to function better after two years and do not face an increased risk of death compared to those who receive medical therapy only. Specific subgroups were identified in the assessment of risk and functional benefits from LVRS. Lung Volume Reduction Surgery The National Emphysema Treatment Trial (NETT) study results have identified four sub-groups of patients who had different risks and benefits from LVRS.
A high-risk patient has been defined by the NETT criteria as the patient who would not benefit from LVRS but is more likely to be harmed, as outlined in GROUP 4 above. Specifically, the high-risk patient is one who has a forced expiratory volume in the first second (FEV1) that is 20% or less of their predicted value and either homogenous distribution of emphysema on CT scan or low carbon monoxide diffusing capacity (DLCO) that is 20% or less of their predicted value. These specific criteria can be determined after the testing process has been completed. Finally, a patient with a certain underlying medical disease, condition or multiple surgical risk factors may also not be a surgical candidate for LVRS. LVRS candidates who fall into Groups 1, 2 or 3 are the best candidates for LVRS. All LVRS candidates are encouraged to discuss their individual charateristics with their primary care provider or pulmonologist to deterne if they are likely to benefit from LVRS.
LVRS AT USCD MEDICAL CENTER Testing, evaluations, medical treatment, and follow-up visits are conducted at UCSD Medical Center. Rehabilitation for patients is available at UCSD. The surgery, using a median sternotomy approach, is performed at UCSD.
MORE INFORMATION FOR PHYSICIANS AND PATIENTS To refer a patient or to obtain more information Medical information on potential NETT patients is requested from the referring physician and includes spirometry, chest x-ray, EKG and medical history. Candidates are then required to complete extensive additional testing.
OTHER LVRS CENTERS
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Pulmonologist Gordon Yung, MD