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In cases where patients have severe emphysema or COPD, lung volume reduction (LVR) may be an option to help you or your loved one breath easier.

Our LVR specialists are experts in performing this procedure, both as traditional surgery and by minimally invasive procedures.

To make an appointment, please call 410-328-8138.

How LVR Works

Emphysema causes air trapping and destruction of the lung tissue. When this occurs, the chest wall mechanics of breathing, including your diaphragm, are impaired. The diaphragm is the main muscle of breathing, it is what separates your chest from your abdominal cavity.

When you take a deep breath in, the diaphragm flattens, and when you take a deep breath out, the diaphragm pushes up. It is the same principle as a bellows.

With severe emphysema, the diaphragm is forced to be in a flattened position, because the lung tissue is hyperinflated.

Lung volume reduction allows for the most disease portion of the lung to be removed or reduced so that the better working portion of the lung can be used more efficiently. The diaphragm then has a better ability to move in the way it is designed to.

When the correct candidates are chosen for this therapy, the benefits seen are better quality of life, improved pulmonary function tests, improved shortness of breath.

Candidates for LVRS

Lung volume reduction patient candidacy is founded on the trials which helped to determine which patients benefited the most from each procedure. The National Emphysema Treatment Trial (NETT) is the data used for selection of surgical patients.

The endobronchial valve literature comes from the EMPROVE and LIBERATE trials.

In general the ideal patient will have the following:

  • Quit smoking for at least 3 months before the procedure date
  • CT chest showing emphysema
  • Pulmonary Function Tests full study (FEV1 15-45%, RV >175%, TLC >100%)
  • Echocardiogram (LVEF >45%, absence of pulmonary hypertension >45mmhg sPAP)
  • Stable on current COPD regimen without recurrent exacerbations
  • BMI <35
  • Completion of pulmonary rehabilitation
  • Patients with prior lung transplant, LVRS, sternotomy, and lobectomy are not ideal candidates but may be carefully considered.

Additional studies will be ordered by the treating thoracic surgeon or pulmonologist and may include ventilation/perfusion scan, 6-minute walk test, ABG. If you are a referring physician and would like to learn more about our exclusion and inclusion criteria, or have a patient who may fall outside of these parameters and would like to discuss their case, don't hesitate to call for further discussion.

Types of LVRS

We evaluate each patient to find the best approach to care.

Surgery

Surgical lung volume reduction (LVRS) is achieved by making an incision on both sides of the chest, and removing a portion of both upper lobes of the lung. This type of surgery is call video assisted thoracoscopic surgery (VATS), and are small incisions. Traditional approaches to this surgery were done by sternotomy (cutting of the breastbone).

At UMMC, we specialize in minimally invasive surgical techniques by VATS. This is done in the operating room by a thoracic surgeon. After the surgery is complete you will stay in the hospital for about one week with chest tubes in each side.

Bronchoscopic Lung Volume Reduction (BLVR)

This is a minimally invasive procedure that is done in the operating room during a bronchoscopy.

A lighted flexible tube is placed into your airway. This allows for visualization of the airways to each lobe of the lung. The interventional pulmonologist then places an FDA-approved endobronchial one way valve to occlude the airways that lead to one lobe of the lung. This causes that lobe to deflate, creating a reduced volume in the chest by a non-surgical means. After this procedure you will stay in the hospital for 3-5 days, as there is a risk of pneumothorax in those first few days.

Make an Appointment

Many patients wish to be considered and evaluated for both surgical and bronchoscopic lung volume reduction. This can be achieved in our multidisciplinary clinic. Contact information for our LVR specialist:

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