ABSTRACT
Lung volume reduction surgery (LVR) is an old operation that was recently revived as a treatment for emphysema. Otto Brantigan pioneered the procedure and performed it on a group of patients in the 1950s, reporting symptomatic improvement in 75%. However, the inability to objectively document improvements in pulmonary function and the early mortality rate of 16% in Brantigan’s series led to abandonment of the operation. In the early 1990s, Joel Cooper reintroduced the procedure in a series of 20 highly selected patients operated on with no mortality and with dramatic improvements in dyspnea, pulmonary function, and quality of life. Although the procedure has continued to engender significant controversy, resulting in the establishment of several multicenter randomized clinical trials in an attempt to rigorously determine its efficacy, a plethora of evidence now exists that selected patients with emphysema benefit from LVR. The National Emphysema Treatment Trial (NETT) has established that most hyper expanded patients with FEV, less than 45% predicted, who have apical predominate disease, and even some patients with homogeneous disease and very low exercise capacity as measured by bicycle ergometry are candidates for the operation.
