PT  - JOURNAL ARTICLE
AU  - Daniela Gompelmann
AU  - Felix Herth
AU  - Ralf Eberhardt
AU  - Steven Kesten
AU  - Claus Peter Heussel
TI  - Efficacy of bronchoscopic thermal vapor ablation and lobar fissure completeness
DP  - 2011 Sep 01
TA  - European Respiratory Journal
PG  - p3530
VI  - 38
IP  - Suppl 55
4099  - http://erj.ersjournals.com/content/38/Suppl_55/p3530.short
4100  - http://erj.ersjournals.com/content/38/Suppl_55/p3530.full
SO  - Eur Respir J2011 Sep 01; 38
AB  - Background: Bronchoscopic thermal vapor ablation (BTVA) ablates emphysematous tissue through a localized inflammatory response followed by contractive fibrosis and atelectasis leading to permanent lung volume reduction that should not be influenced by collateral ventilation.Objectives: To determine the correlation of clinical data from a trial of BTVA to computed tomography (CT) assessment of fissure integrity.Methods: Single arm study (n= 44) of patients with heterogeneous upper lobe predominant emphysema with FEV1<45% predicted. Patients received BTVA to the RUL or LUL in a single setting. Primary efficacy outcomes: FEV1 and SGRQ at 6 months. Efficacy: lobar volume reduction (LoVR) from thin section multislice CT, spirometry, body plethysmography, 6MWD and mMRC dyspnea score. The treated lobar fissure was analyzed visually in non-enhanced pre-interventional CT. Incompleteness of small fissure, upper half of right large fissure, and three thirds of left large fissure were estimated in 5% increments and the relative amount of fissure incompleteness calculated. Pearson correlation coefficients were calculated for the association between fissure incompleteness and change in efficacy outcomes (baseline to 6 months).Results: Mean age 62 years, 50% men, FEV1 0.85 L (31% predicted), SGRQ 59 units, 6MWD 300m. Calculated relevant fissure incompleteness was 13% (median) (range 0-63%). 38/44 patients (86%) had incompleteness in the relevant fissure. Correlation coefficients (r) for the association of incompleteness to outcomes are as follows: FEV1 0.17, LoVR -0.27, SGRQ -0.10, 6MWD 0, RV -0.18, RV/TLC -0.14.Conclusion: BTVA induced LoVR and improvements in clinical outcomes are independent of fissure integrity.