PURPOSE: Bronchoscopic lung-volume reduction (LVR) may lead to improvement in pulmonary function and exercise tolerance in patients with severe heterogenous emphysema. We evaluated the feasibility and short term outcome for one-way valve placement (Emphasys EBV™) in patients with homogenous emphysema.A prospective pilot study for proof of principle and safety was conducted.
METHODS: 10 patients (5 women, 5 men) entered this pilot study. In all cases a homogenous distribution was confirmed by computer analysis of the emphysema score in the CT-scan. We performed unilateral LVR and aimed to occlude the lobe with the lowest perfusion, measured by nuclear scintigraphy. Symptoms were assessed with the SGRQ.
RESULTS: Preoperative mean forced expiratory volume in 1 second (FEV1) was 0.85 liters (range 0.55–1.36), mean residual volume was 5.07 liters (range 3.55–8.24) and six-minute-walk-test was 301 meters (range 150–480). Seven out of 10 patients reported symptomatic improvement, which was confirmed by better PFTs and 6MWT in 4 cases. When analyzing the data for the whole group, no major changes in lung function were evident at 30 days and 90 days. A trend towards improvement was observed in six-minutes-walk-test at 3 months (+20.9 m). No severe complications and no pneumothorax were noticed, but in one case the valves had to be removed after 90 days because of recurrent infections.
CONCLUSION: This first study shows that bronchoscopic lung volume reduction in patients with severe homogenous emphysema is feasible and safe and selected patients may benefit from the intervention. Longer term follow–up and patient selection criteria have to be examined in a larger trial.
CLINICAL IMPLICATIONS: Bronchoscopic LVR may be beneficial in patients with severe homogenous emphysema.
DISCLOSURE: Ralf Eberhardt, No Financial Disclosure Information; No Product/Research Disclosure Information