These are only general guidelines and every patient will be evaluated on an individual basis.
Inclusion:
- Ex-smokers (≥4 months)
- PFT:
- Post BD FEV1 15 – 45%
- TLC ≥100%
- RV ≥150%
- 6MWD
- ≥ 100 – <500 meters after pulmonary rehabilitation program
- BMI <35 Kg/m2
- Completed pulmonary rehabilitation program (or is enrolled and completed 6-8 sessions)
- ABG: PaCO2 <60 on room air, PaO2 >45 on room air
- Stable on prednisone <20mg/day
Exclusion:
- Any contraindication to bronchoscopy and/or general anesthesia
- Lung findings:
- Pulmonary nodule requiring work up
- Giant bullae (>1/3 hemithorax). May be referred for bullectomy
- Comorbidities:
- Recent CV event (6 months)
- Recent CVA (3 months)
- Known uncontrolled PAH sPAP >60
- Prior lobectomy, LVRS, lung transplant, median sternotomy
- Careful consideration in:
- CHF w/EF <45%
- FEV 1 < 15%
- DLCO <20%
- Baseline 6MWD <100m
- Lack of access to medical care
Tests required within 1 year:
- Chest
CT:
- Chest CT with SD (super dimension protocol done at HFHS)
- We can rule in with outside CT (minimum requirement HRCT inspiration only <1.5mm cuts, contrasted images are not analyzable) if done within 1 year. However, we do not rule out based upon outside images
- Complete PFT
- ABG
- 6MWT
- TTE
- Perfusion scan ordered on an individual basis. To be determined after IP clinic visit and complete evaluation
Lobe selection process
- Little to No Collateral Ventilation
- Fissure completeness ≥80% preoperatively (StratX). Fissure <80% rules out
- Intraoperative confirmation with balloon (Chartis) that lobe is CV-
- Higher Destruction
- Emphysema score ≥45% on QCT (Stratx)
- Prefer lobe with greatest destruction
- Larger Lobe Volume
- Less Perfusion
- Perfusion scan may be used when multiple valid target lobes are available
- Consider if ipsilateral heterogeneity score is low
- Greater Heterogeneity
- Heterogeneity score ≥10% (difference in emphysema score between the target and ipsilateral lobe)