Lung volume reduction surgery in the candidate for lung transplantation

Emphysema is a progressive, unrelenting disease that results in a continued decline in pulmonary function. When pulmonary function testing documents a forced expiratory volume in 1s (FEV₁) of less than 30% predicted values, the 3-year mortality risk has been estimated at 40% to 50%. Because of the increased mortality and the decreased quality of life seen with severe emphysema, multiple surgical treatments have been devised for patients with emphysema. The majority of these surgical interventions have been subsequently abandoned because of the lack of reproducible benefits and the false physiological principles upon which they were based. An excellent published review on the history of emphysema surgery has been provided by Deslauriers. As surgeons and physicians gained a better understanding of the pathophysiology of emphysema, most of these procedures would be considered of historical interest with no current practical value.