Bronchoscopic lung-volume reduction with one-way valves in patients with heterogenous emphysema.
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.
Venuta
Federico
F
Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy. sofed@libero.it
de Giacomo
Tiziano
T
Rendina
Erino A
EA
Ciccone
Anna Maria
AM
Diso
Daniele
D
Perrone
Alessandro
A
Parola
Daniela
D
Anile
Marco
M
Coloni
Giorgio F
GF
D000328:Adult; D000368:Aged; D001980:Bronchi / Q000601:surgery*; D001986:Bronchial Spasm / Q000209:etiology; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D004646:Emphysema / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005336:Fiber Optic Technology; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010865:Pilot Projects; D011014:Pneumonia / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D019736:Prostheses and Implants; D016896:Treatment Outcome