scholarly journals Implementation of Bronchoscopic Lung Volume Reduction Using One-Way Endobronchial Valves: A Retrospective Single-Centre Cohort Study

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Rein Posthuma ◽  
Anouk W. Vaes ◽  
Kim H. M. Walraven ◽  
Peyman Sardari Nia ◽  
Jan U. Schreiber ◽  
...  
Keyword(s):  
Lung Volume ◽  
Real Life ◽  
High Volume ◽  
Forced Expiratory Volume ◽  
Outcome Data ◽  
Volume Reduction ◽  
Small Subset ◽  
Lung Volume Reduction ◽  
Invasive Treatment

<b><i>Background:</i></b> Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program. <b><i>Objectives:</i></b> In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes. <b><i>Method:</i></b> A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV<sub>1</sub>), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample <i>t</i> tests were performed to compare means before and after intervention. <b><i>Results:</i></b> Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (<i>n</i> = 2) or lack of benefit (<i>n</i> = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT −4 ± 6 points, FEV<sub>1</sub> +190 ± 140 mL, RV −770 ± 790 mL, and +37 ± 65 m on the 6MWT (all <i>p</i> &#x3c; 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. <b><i>Conclusion:</i></b> Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.

scholarly journals Endoscopic lung volume reduction with endobronchial valves in very low DLCO patients: results from the German Registry (Lungenemphysemregister e.V.)

2020 ◽  
pp. 00449-2020
Author(s):  
Pavlina Lenga ◽  
Christoph Ruwwe-Glösenkamp ◽  
Christian Grah ◽  
Joachim Pfannschmidt ◽  
Jens Rückert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Exercise Capacity ◽  
Lung Volume ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
Lung Emphysema

BackgroundEndoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusion capacity of the lung for carbon monoxide (DLCO). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to DLCO for patients treated with ELVR.MethodsWe assessed DLCO at baseline and 3-months follow-up and compared pre- and postprocedural pulmonary function test (PFT), quality of life, exercise capacity and adverse events. This is a retrospective subanalysis of prospectively collected data from the German Lung Emphysema Registry.Results121 patients treated with ELVR were analysed. 34 patients with a DLCO ≤20% and 87 patients with a DLCO >20% showed similar baseline characteristics. After ELVR, there was a decrease of residual volume (both p<0.001 to baseline) in both groups and both demonstrated better quality of life (p<0.01 to baseline). Forced expiratory volume in 1 s (FEV1) improved significantly only in patients with a DLCO >20% (p<0.001 to baseline). Exercise capacity remained almost unchanged in both groups (p=0.3). The most frequent complication for both groups was a pneumothorax (DLCO ≤20%: 17.6% versus DLCO >20%: 16.1%; p=0.728). However, there were no significant differences in other adverse events between both groups.ConclusionsELVR improves lung function as well as quality of life in patients with DLCO >20% and DLCO ≤20%. Adverse events did not differ between groups. Therefore, ELVR should be considered as a treatment option, even in patients with a very low DLCO.

scholarly journals Delayed results of lung volume reduction surgery in heterogeneous lung emphysema

2005 ◽  
pp. 84-86
Author(s):  
P. Wex ◽  
V. Haas ◽  
E. Utta
Keyword(s):  
Lung Volume ◽  
Oxygen Therapy ◽  
Postoperative Mortality ◽  
Volume Reduction ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Walk Distance ◽  
Lung Emphysema ◽  
Blood Gas Parameters

The aim of the study was to search delayed results and to characterize patients with heterogeneous emphysema which do not improve their quality of life after lung volume reduction surgery. Retrospective analysis was done based on medical history reports from July, 1994, to January, 1998. The surgical lung volume reduction was performed in 81 patients (45 males and 13 females, the average age was 61.9 yrs). Postoperative mortality was 6.9 % (4 patients). Twenty-three patients died within 5 yrs after the intervention; their mean follow-up period was 33.3 months. The average follow-up period was 54.3 months. Functional parameters for patients survived 3 to 5 yrs were: FEV1 50 ± 23.8 %, RV 35.6 ± 29.1 %, RV / TLC 12.3 ± 12 %, the 6-min walk distance was 96.7 ± 62 m. The total 5-year survival was 63.8 %, the survival for the patients having FEV1> 30 % was 83.8 % and that for the patients with FEV1 < 30 % was 50 %. Age and lung function parameters did not differ in survivors and died patients. On the contrary, differences in the blood gas parameters, oxygen therapy time and 6-min walk distance were significant between these groups. Some negative factors were revealed: predominant injury of the lower lung fields, FEV1 < 30 % pred., respiratory failure (PaCO2 ≥ 48 mm Hg), oxygen therapy longer than 6 months, the 6-min walk distance shorter than 80 m.

scholarly journals Long‐term follow‐up after bronchoscopic lung volume reduction treatment with coils in patients with severe emphysema

Respirology ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 319-326 ◽  
Author(s):  
Jorine E. Hartman ◽  
Karin Klooster ◽  
Kiki Gortzak ◽  
Nick H.T. Hacken ◽  
Dirk‐Jan Slebos
Keyword(s):  
Lung Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction ◽  
Severe Emphysema ◽  
Reduction Treatment ◽  
Long Term Follow Up

Physiological characterization of variability in response to lung volume reduction surgery

2003 ◽  
Vol 94 (1) ◽  
pp. 20-30 ◽  
Author(s):  
Edward P. Ingenito ◽  
Stephen H. Loring ◽  
Marilyn L. Moy ◽  
Steven J. Mentzer ◽  
Scott J. Swanson ◽  
...  
Keyword(s):  
Lung Volume ◽  
Airway Resistance ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Mechanics ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Recoil Pressure ◽  
Physiological Characterization

This paper examines potential physiological mechanisms responsible for improvement after lung volume reduction surgery (LVRS). In 25 patients (63 ± 9 yr; 11 men, 14 women), spirometry [forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)], lung volumes [residual volume (RV) and total lung capacity (TLC)], small airway resistance, recoil pressures, and respiratory muscle contractility (RMC) were measured before and 4–6 mo after LVRS. Data were interpreted to assess how changes in each component of lung mechanics affect overall function. Among responders (ΔFEV1 ≥ 12%; 150 ml), improvement was primarily due to an increase in FVC, not to FEV1-to-FVC ratio. Among nonresponders, FEV1, FVC, and RV/TLC did not change after surgery, although recoil pressure increased in both groups. Both groups experienced a reduction in RMC after LVRS. In conclusion, LVRS improves function in emphysema by resizing the lung relative to the chest wall by reducing RV. LVRS does not change airway resistance but decreases RMC, which attenuates the potential benefits of LVRS that are generated by reducing RV/TLC. Among nonresponders, recoil pressure increased out of proportion to reduced volume, such that no increase in vital capacity or improvement in FEV1 occurred.

Is bronchoscopic follow up useful after Bronhoscopic Lung Volume Reduction (BLVR) with endobronchial valves?

2018 ◽  
Author(s):  
Valentina Luzzi ◽  
Margherita Innocenti ◽  
Sofia Romani ◽  
Fausto Leoncini ◽  
Michela Bezzi
Keyword(s):  
Lung Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction

scholarly journals Effectiveness of Endobronchial Coil Treatment for Lung Volume Reduction in Patients with Severe Heterogeneous Emphysema and Bilateral Incomplete Fissures: A Six-Month Follow-Up

Respiration ◽  
2014 ◽  
Vol 88 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Konstantina Kontogianni ◽  
Vasiliki Gerovasili ◽  
Daniela Gompelmann ◽  
Maren Schuhmann ◽  
Claus Peter Heussel ◽  
...  
Keyword(s):  
Lung Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction

scholarly journals Individualised risk in patients undergoing lung volume reduction surgery: the Glenfield BFG score

2017 ◽  
Vol 49 (6) ◽  
pp. 1601766 ◽  
Author(s):  
Neil J. Greening ◽  
Paul Vaughan ◽  
Inger Oey ◽  
Michael C. Steiner ◽  
Mike D. Morgan ◽  
...  
Keyword(s):  
Risk Score ◽  
Lung Volume ◽  
Characteristic Curve ◽  
Risk Groups ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Chronic Obstructive ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Obstructive Pulmonary Disease

Lung volume reduction surgery (LVRS) has been shown to be beneficial in patients with chronic obstructive pulmonary disease, but there is low uptake, partly due to perceived concerns of high operative mortality. We aimed to develop an individualised risk score following LVRS.This was a cohort study of patients undergoing LVRS. Factors independently predicting 90-day mortality and a risk prediction score were identified. Reliability of the score was tested using area under the receiver operating characteristic curve (AUROC).237 LVRS procedures were performed. The multivariate analysis factors associated independently with death were: body mass index (BMI)<18.5 kg·m−2 (OR 2.83, p=0.059), forced expiratory volume in 1 s (FEV1)<0.71 L (OR 5.47, p=0.011) and transfer factor of the lung for carbon monoxide (TLCO) <20% (OR 5.56, p=0.031). A risk score was calculated and total score assigned. AUROC for the risk score was 0.80 and a better predictor than individual components (p<0.01). The score was stratified into three risk groups. Of the total patients, 46% were classified as low risk. Similar improvements in lung function and health status were seen in all groups. The score was introduced and tested in a further 71 patients. AUROC for 90-day mortality in this cohort was 0.84.It is possible to provide an individualised predictive risk score for LVRS, which may aid decision making for both clinicians and patients.

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