Lung Volume Reduction Surgery Safe, Effective in PH Patients with Emphysema, Study Suggests

Having pulmonary hypertension (PH) does not affect the benefits of lung volume reduction surgery for people with emphysema, who experience improved lung function and better quality of life, a new study suggests.

The study, published in The Annals of Thoracic Surgery, was titled “Pulmonary Hypertension: A Contraindication for Lung Volume Reduction Surgery?”

Lung volume reduction, a procedure to remove diseased lung tissue, is the preferred treatment for select patients with emphysema, a condition that causes shortness of breath due to damage in the alveoli, or the lungs’ tiny air sacs. Due to safety concerns, this surgery has not been recommended for people with PH. However, recent studies showed better lung function and improved breathing in select PH patients with emphysema after the procedure.

To learn more, researchers at the Southern Illinois University School of Medicine analyzed data from 124 people (mean age 66 years) who underwent lung volume reduction for emphysema at their clinic between 2006 and 2016.

Among the patients, 56 (45%) had pulmonary hypertension — 48 mild-to-moderate and eight severe. No demographic differences were found at the start of the study (baseline) between the groups with and without PH.

Results showed similar post-surgery and in-hospital clinical outcomes between the individuals with and without PH, including length of hospital stay, days in intensive care, and use of ventilators.

Compared with baseline values, lung function improved significantly among participants with PH. Indeed, the percent-predicted forced expiratory volume in one second (FEV1%) increased from an average of 26 to 38 one year after surgery, and forced vital capacity (FVC) increased from 62 to 90 in the same timeframe. Both FEV1 and FVC are measurements of how much air a person can exhale, and are commonly used to assess lung function.

Similar benefits were found in diffusion capacity of the lungs for carbon monoxide (DLCO%, 36 to 43), which measures gas transfer from the lungs’ air sacs (alveoli) to the blood stream.

Importantly, all of these improvements were comparable to those seen in participants who did not have PH. Improvements in other metrics — including the six-minute walk test of exercise tolerance and quality of life — also were comparable between the two groups.

Mortality rates also were similar in both groups. During the one-year period following surgery, 11 patients died: six had PH and five did not. Most deaths were due to respiratory failure, including five that occurred in the hospital and three within one year of discharge.

Researchers also sent surveys to the surgeons who performed the procedures to ascertain perceptions in the field. Among the 51 surgeons who responded, approximately half said the procedure should not be denied based solely on PH. In addition, only 22% believed that elevated pulmonary arterial pressure affects post-surgery functional outcomes.

“PH within this cohort [group] did not seem to impact the outcomes in patients with emphysema undergoing LVRS [lung volume reduction surgery],” the researchers said.

“Lung volume reduction surgery may be a potential option for select emphysema patients with PH,” they concluded.