TY - JOUR T1 - Effect of fissure integrity on the efficacy of bronchoscopic lung volume reduction therapy using a peripheral acting tissue sealant in patients with advanced upper lobe predominant emphysema JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p3529 AU - Helgo Magnussen AU - Anne-Marie Kirsten AU - Felix Herth AU - Ralf Eberhardt AU - Franz Stanzel AU - Reiner Bonnet AU - Juergen Behr AU - Mordechai Kramer Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p3529.abstract N2 - Objective(s): Results from the VENT Study (Sciurba F et al, NEJM 2010) indicate that endobronchial valve therapy is most effective in patients with upper lobe predominant heterogeneous (ULP) emphysema who have intact fissures. This study examines how fissure integrity affects the response to endobronchial volume reduction performed with the AeriSeal Emphysematous Lung Sealant System (ELS), a peripheral-acting tissue sealant.Methods: Lung volumes, tissue density, and disease heterogeneity were assessed by CT scanning in 27 patients (age 62.6±7.5 yrs, 19 male) with advanced ULP emphysema before and after ELS therapy. Post-treatment changes in lobar and total lung volumes were correlated with fissure integrity and with physiological, functional and quality of life outcomes out to 6 months.Results: ELS therapy reduced lobar volumes independent of fissure integrity. In ULP patients treated on the side of a complete fissure (n=12), lobar volume reduction was 530±323 mL, vs 406±330 mL on the side of an incomplete fissure (n=15; p=0.304). Improvements in pulmonary function (Complete vs Incomplete: ΔFEV1 = +8.5% vs 8.9%), functional capacity (ΔMRCD = -1.1U vs -0.5U; Δ6MWD = +43.3m vs +41.0m), and quality of life (ΔSGRQ = -6.0U vs -7.9U) were similar in ULP patients with and without complete fissures although overall reductions in RV/TLC (ΔRV/TLC = -6.7% vs -1.8%) were greater in those with complete fissures.Conclusions: Fissure integrity had minimal impact on the overall response to endobronchial lung volume reduction therapy performed using ELS in patients with advanced ULP emphysema. ER -