Abstract
Of 59 patients with emphysema treated with endobronchial valves (EBV) at our institution, nine were submitted to multistage strategies with placement of additional valves at varying intervals to complement initial treatment or compensate for the natural decline associated with aging in this chronic disorder. All had severe emphysema with heterogeneity > 15% as measured by parenchymal density <-950HU. Three types of multistage strategies were used: bilateral (left/right), replacement (removal and reinsertion of valves), and progressive (nonlobar to lobar exclusion, upper/lower). Advantages of multistaging include protection from abrupt physiological changes and pneumothorax. Also, in the absence of clear clinical signs to predict response, multistaging allows a change in treatment approach, and clearly demonstrates the safety of EBVs.
Multistage strategies should be considered in all valve patients as part of their routine follow-up.
- © 2011 ERS