Is pulmonary hypertension still a contraindication for lung volume reduction?—a narrative review of contemporary evidence

Severe emphysema in chronic obstructive pulmonary disease causes lung hyperinflation, increased intrathoracic pressure and loss of pulmonary vasculature, which together contribute to pulmonary hypertension (PH) and right heart dysfunction. Historically, PH was considered an absolute contraindication to lung volume reduction surgery (LVRS) because clinicians feared that removing lung tissue and pulmonary vessels would raise pulmonary artery pressures and provoke right-heart failure. The objective of this narrative review is to synthesize recent evidence on the safety, feasibility and haemodynamic impact of LVRS and bronchoscopic lung volume reduction (BLVR) in patients with emphysema-associated PH and to propose practical recommendations for future research and clinical practice.