Potential indications and contraindications for LVRS

Parameter	Indications	Contraindications
Clinical	Age <75 years	Age ≥75 years
	Ex-smoker (>6 months)	Current smoking
	Clinical picture consistent with emphysema	Surgical constraints (eg, previous thoracic procedure, pleurodesis, chest wall deformity)
	Dyspnea despite maximal medical therapy and pulmonary rehabilitation	Pulmonary hypertension (PA systolic >45 mmHg, PA mean >35 mmHg)
Comorbid illness*		Clinically significant bronchiectasis
		Clinically significant coronary heart disease
		Heart failure with an ejection fraction <45 percent
		Uncontrolled hypertension
		Obesity^¶
Physiology	FEV1 after bronchodilator <45 percent predicted	FEV1 ≤20 percent predicted with either DLCO ≤20 percent predicted or homogeneous emphysema
	Hyperinflation (TLC >100 percent predicted, RV >150 percent)	PaO2 ≤45 mmHg on room air
	Post rehabilitation 6-minute walk distance >140 meters	PaCO2 ≥60 mmHg
	Low post rehabilitation maximal achieved cycle ergometry watts^Δ
Imaging	Chest radiograph - hyperinflation
	HRCT confirming severe emphysema, ideally with upper lobe predominance	Homogeneous emphysema with FEV1 ≤20 percent predicted
		Significant pleural or interstitial changes on HRCT
		Nonupper lobe predominant emphysema and high post rehabilitation maximal achieved cycle ergometry watts^◊

FEV1: forced expiratory volume in one second; TLC: total lung capacity; RV: residual volume; PaO2: arterial partial pressure of oxygen; PaCO2: arterial partial pressure of carbon dioxide; HRCT: high resolution computed tomography.
* Comorbid illnesses may be considered relative contraindications depending on degree of severity.
¶ The NETT trial required a body mass index less than 31.1 kg/m2 for men and less than 32.3 kg/m2 for women. It is not known whether more severe obesity would adversely affect perioperative risk.
Δ Low post rehabilitation maximal achieved cycle ergometry watts (W) is defined as at or below the sex specific 40th percentile (25 W for women and 40 W for men).
◊ High post rehabilitation maximal achieved cycle ergometry watts (W) is defined as above the sex specific 40th percentile (25 W for women and 40 W for men). This is a relative contraindication.

Data from: www.thoracic.org/COPD.

Graphic 69501 Version 2.0

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Potential indications and contraindications for LVRS