A multicenter pilot study of a bronchial valve for the treatment of severe emphysema.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) affects millions of people and has limited treatment options. Surgical treatments for severe COPD with emphysema are effective for highly selected patients. A minimally invasive method for treating emphysema could decrease morbidity and increase acceptance by patients.


OBJECTIVE
To study the safety and effectiveness of the IBV(R) Valve for the treatment of severe emphysema.


METHODS
A multicenter study treated 91 patients with severe obstruction, hyperinflation and upper lobe (UL)-predominant emphysema with 609 bronchial valves placed bilaterally into ULs.


RESULTS
Valves were placed in desired airways with 99.7% technical success and no migration or erosion. There were no procedure-related deaths and 30-day morbidity and mortality were 5.5 and 1.1%, respectively. Pneumothorax was the most frequent serious device-related complication and primarily occurred when all segments of a lobe, especially the left UL, were occluded. Highly significant health-related quality of life (HRQL) improvement (-8.2 +/- 16.2, mean +/- SD change at 6 months) was observed. HRQL improvement was associated with a decreased volume (mean -294 +/- 427 ml, p = 0.007) in the treated lobes without visible atelectasis. FEV(1), exercise tests, and total lung volume were not changed but there was a proportional shift, a redirection of inspired volume to the untreated lobes. Combined with perfusion scan changes, this suggests that there is improved ventilation and perfusion matching in non-UL lung parenchyma.


CONCLUSIONS
Bronchial valve treatment of emphysema has multiple mechanisms of action and acceptable safety, and significantly improves quality of life for the majority of patients.
Sterman
D H
DH
University of Pennsylvania Medical Center, Philadelphia, PA 19104-4283, USA. daniel.sterman@uphs.upenn.edu
Mehta
A C
AC
Wood
D E
DE
Mathur
P N
PN
McKenna
R J
RJ
Ost
D E
DE
Truwit
J D
JD
Diaz
P
P
Wahidi
M M
MM
Cerfolio
R
R
Maxfield
R
R
Musani
A I
AI
Gildea
T
T
Sheski
F
F
Machuzak
M
M
Haas
A R
AR
Gonzalez
H X
HX
Springmeyer
S C
SC
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D001999:Bronchoscopy; D020878:Device Removal; D005080:Exercise Test; D005260:Female; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000627:therapeutic use; D010865:Pilot Projects; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects; D011652:Pulmonary Circulation; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D010100:Oxygen