Original article
General thoracic
Bronchoscopic Lung-Volume Reduction With One-Way Valves in Patients With Heterogenous Emphysema

https://doi.org/10.1016/j.athoracsur.2004.07.048Get rights and content

Background

We evaluated the feasibility and short-term functional outcome after bronchoscopic lung-volume reduction performed with one-way valves in patients with severe heterogeneous emphysema.

Methods

Thirteen patients entered this pilot study. Endobronchial one-way valves were placed in the segmental bronchi supplying the most hyperinflated parts of the emphysematous lungs to allow lung deflation, reduce lung volume, and alleviate symptoms. The valves and delivery catheter were inserted under intravenous anesthesia and spontaneous assisted ventilation, with visual control through a flexible bronchoscope. We performed unilateral bronchoscopic lung-volume reduction in 11 patients and staged bilateral procedures in 2. Preoperative median forced expiratory volume in 1 second (FEV1) was 0.75 L/s (22%), residual volume was 5.3 L (233%), total lung capacity, 7.9 L (123%); intrathoracic gas volume, 6.5 L (176%); and 6-minute walk test, 223 meters. All patients required supplemental oxygen at rest (1.4 L/min). The median preoperative Medical Research Council (MRC) scale dyspnea score was 4.

Results

Six complications occurred in 3 patients: two bilateral and one contralateral pneumothorax, one pneumonia, and two episodes of bronchospasm. Functional results at 1 and 3 months showed a significant improvement in FEV1, residual volume, and 6-minute walk test; 43% of the patients were able to completely stop supplemental oxygen. The posttreatment MRC median dyspnea score at 1 and 3 months was 2. Bronchoscopic follow up at 1 and 3 months showed that the valves were correctly in place with no granulation.

Conclusions

Bronchoscopic lung-volume reduction with one-way valves can be performed with acceptable short-term safety and worthwhile functional benefits.

Section snippets

Material and Methods

We conducted a prospective, nonrandomized, single-center longitudinal study to evaluate the safety and short-term efficacy of BLVR performed by placing one-way endobronchial valves (Emphasys, Redwood City, CA) in the bronchi supplying the most hyperinflated parts of the emphysematous lungs. Thirteen patients (12 men, 1 woman; median age, 56 years; range, 32 to 71) entered this pilot study during a 14-month period.

Results

Fifty-nine valves were placed (median 4 per patient; range 2 to 6); the devices were placed in the right upper lobe in 6 treatments (40%), in the right upper and middle lobe in 1 (7%), in the left upper lobe in 3 (20%), and in the right and left lower lobes in 3 (20%) and 2 (13%) cases, respectively. The median operative time was 45 minutes (range 20 to 95 minutes). No intraoperative complications were observed.

All patients were extubated immediately after the procedure and returned to the

Comment

Surgical lung-volume reduction (LVRS) can now be considered an effective palliation for a selected group of patients with advanced emphysema 6, 7. It provides improved pulmonary function, quality of life, and exercise tolerance 16, 17 with an accepted mortality of 5% to 10% [18]. Morbidity has still an impact, with a significant percentage of patients showing prolonged air leaks 16, 18. LVRS is not always indicated, however. In fact, patients with the most advanced disease show a higher

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