LVRS

Question 1

Indications/Contraindications: DLCO and FEV1

Answer 1

FEV1 >20 but <45
DLCO >20 but <80
FEV1<15 in >70yo is contraindication

Question 2

Indications for LVRS

Answer 2

Acceptable risk and do pre/post rehab
Smoking cessation >6m
Upper lobe predominant
Post rehab SMWT > 500ft
FEV1 <45% predicted
DLCO < 80% predicted
RV > 150% predicted
TLC > 100% predicted
PaCO2 < 55
PaO2 >45

Question 3

Contraindications to LVRS

Answer 3

Comorbidities, obesity, chest wall deformities, low EF or CAD, pHTN (mPAP>35)
Previous pleurodesis or thoracotomy
Non upper lobe predominant or homogenous
FEV1 or DLCO <20 predicted
FEV1 < 15 predicted if over 70
PaCO2 >55
Exercise O2 req > 6LPM

Question 4

NETT trial: survival advantage group

Answer 4

Lower preop ET
Upper lobe predominant

Question 5

NETT trial: increased risk of death with LVRS

Answer 5

Higher preop ET
Non upper lobe predominant