Heterogeneity of Lung Volume Reduction Surgery Outcomes in Patients Selected by Use of Evidence-Based Criteria Matthew R. Lammi, MD, Nathaniel Marchetti,

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Heterogeneity of Lung Volume Reduction Surgery Outcomes in Patients Selected by Use of Evidence-Based Criteria Matthew R. Lammi, MD, Nathaniel Marchetti, DO, Shari Barnett, MD, Gerard J. Criner, MD The Annals of Thoracic Surgery Volume 95, Issue 6, Pages 1905-1911 (June 2013) DOI: 10.1016/j.athoracsur.2013.03.088 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Values before and after surgical procedure for 6-minute walk distance, (B) maximal watts on cardiopulmonary exercise testing, and (C) FEV1 for our cohort (“Temple”) and the upper lobe–predominant surgical group from the National Emphysema Treatment Trial (NETT). Data are presented as mean ± SEM. *A statistically significant improvement from the postrehabilitation to postsurgical variables in our cohort. The Annals of Thoracic Surgery 2013 95, 1905-1911DOI: (10.1016/j.athoracsur.2013.03.088) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Kaplan-Meier survival curves for our cohort (“Temple”) and the National Emphysema Treatment Trial (NETT) subgroups: upper lobe–predominant, low exercise (A) and upper lobe–predominant, high exercise (B). (LVRS = lung volume reduction surgery.) Reprinted from Naunheim et al, Ann Thorac Surg 2006;82:431–43 [17] with permission from Elsevier. The Annals of Thoracic Surgery 2013 95, 1905-1911DOI: (10.1016/j.athoracsur.2013.03.088) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier survival curves for the high versus low exercise group in our cohort. (LVRS = lung volume reduction surgery.) The Annals of Thoracic Surgery 2013 95, 1905-1911DOI: (10.1016/j.athoracsur.2013.03.088) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Baseline maximal watts on postrehabilitation cardiopulmonary exercise testing (CPET) in the low exercise patients who died (“Low-died”) compared with the low exercise patients who survived for more than 3 years (“Low-alive”). The Annals of Thoracic Surgery 2013 95, 1905-1911DOI: (10.1016/j.athoracsur.2013.03.088) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Figure from the supplement to the National Emphysema Treatment Trial article demonstrating the sensitivity analysis of sex-specific cutoff points for subgroups defined according to maximal workload. For the overall trend, there is a greater relative improvement in outcome with operation in the group with a maximum workload ≤40th percentile. However, there is an upward deflection in those with a maximum workload ≤10th percentile. (Reprinted from Fishman et al, N Engl J Med 2003;348:2059–73 [1] with permission from the New England Journal of Medicine.) The Annals of Thoracic Surgery 2013 95, 1905-1911DOI: (10.1016/j.athoracsur.2013.03.088) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions