title: Endoscopic lung volume reduction with endobronchial valves in patients with severe emphysema and established pulmonary hypertension.
abstract: BACKGROUND
  One of the most common forms of pulmonary hypertension (PH) is that associated with chronic obstructive pulmonary disease (COPD). So far, patients with severe emphysema and established PH have been excluded from endoscopic lung volume reduction (ELVR) therapy due to the risk of right heart decompensation.
  
  
  OBJECTIVE
  The aim of this pilot study was to evaluate the feasibility and efficacy of ELVR using one-way endobronchial valves (EBV) in this specific group of patients.
  
  
  METHODS
  We prospectively included 6 patients with COPD, severe heterogeneous emphysema, and established PH who underwent right heart catheterization and clinical assessments before and 90 days after ELVR with unilateral EBV placement.
  
  
  RESULTS
  This study was not powered to measure any statistical differences in endpoints. Ninety days after ELVR, the symptoms, lung function, and hemodynamics improved in 5 out of 6 patients (1 patient normalized and 1 slightly worsened). The mean hemodynamics improved from baseline to 90 days after ELVR as follows: mean pulmonary artery pressure, -2.5 ± 3.5 mm Hg; pulmonary arterial wedge pressure, -4.3 ± 8.3 mm Hg; cardiac index, +0.3 ± 0.6 l/min/m(2), and 6-min walk distance, +59 ± 99 m. ELVR was performed without PH-related complications in all patients.
  
  
  CONCLUSIONS
  To our knowledge, this is the first prospective, single-center pilot study to evaluate the feasibility and efficacy of ELVR in patients with established PH. ELVR was feasible and resulted in an improvement of clinical and hemodynamic parameters in 5 out of 6 patients. These results have to be further confirmed in larger-scale controlled studies.
authors.affiliation: Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Eberhardt
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Gerovasili
authors.forename: Konstantina
authors.initials: K
authors.lastname: Kontogianni
authors.forename: Daniela
authors.initials: D
authors.lastname: Gompelmann
authors.forename: Nicola
authors.initials: N
authors.lastname: Ehlken
authors.forename: Felix J F
authors.initials: FJ
authors.lastname: Herth
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Grünig
authors.forename: Christian
authors.initials: C
authors.lastname: Nagel
mesh_terms: D000368:Aged; D017079:Exercise Tolerance; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D010865:Pilot Projects; D011013:Pneumonectomy / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D012129:Respiratory Function Tests