title: Do endobronchial valves improve outcomes in patients with emphysema?
abstract: A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether endobronchial valves improve outcomes in patients with severe emphysema. Eighty-seven papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Endobronchial Valve for Emphysema Palliation Trial demonstrated that endobronchial valve increased forced expiratory volume in one second by 4.3% (95% confidence interval 1.4-7.2) and decreased by 2.5% in the control group (95% confidence interval -5.4 to 0.4) at a 6-month interval. This benefit is more marked in patients who do not have collateral ventilation into the area of lung being isolated as mapped by bronchoscopic physiological mapping (Chartis) or by computed tomography imaging documenting intact fissures. This evidence is reflected in the Endobronchial Valve for Emphysema Palliation Trial. Patients treated with endobronchial valve with high heterogeneity and complete fissures had greater improvement in forced expiratory volume in one second at 6- and 12-month intervals. We conclude that endobronchial valve placement improves lung function, exercise capacity and quality of life in selected patients with emphysematous diseases.
authors.affiliation: Department of Cardiac Surgery,  Leeds General Infirmary, Leeds,  UK.
authors.forename: Anupama
authors.initials: A
authors.lastname: Barua
authors.forename: Paul
authors.initials: P
authors.lastname: Vaughan
authors.forename: Robin
authors.initials: R
authors.lastname: Wotton
authors.forename: Babu
authors.initials: B
authors.lastname: Naidu
mesh_terms: D019985:Benchmarking; D001999:Bronchoscopy; D019317:Evidence-Based Medicine; D017079:Exercise Tolerance; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation*; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome