title: Sequential Bilateral Bronchoscopic Lung Volume Reduction With One-Way Valves for Heterogeneous Emphysema.
abstract: BACKGROUND
  Clinical benefits of bronchoscopic lung volume reduction with one-way endobronchial valves have been reported for heterogeneous emphysema after unilateral treatment. We assessed the potential role of contralateral treatment to prolong the benefits obtained with the first procedure.
  
  
  METHODS
  This was a retrospective multicenter study including consecutive patients with heterogeneous emphysema undergoing bronchoscopic valves deployment during the last 4 years. Patients were split into two groups depending on the procedure (unilateral versus bilateral). The intergroup differences were evaluated to assess the viability, effectiveness, and safety of the bilateral procedure.
  
  
  RESULTS
  Forty-nine patients were enrolled. Of these, 14 (28%) had a sequential bilateral procedure mainly due to loss of the clinical benefits obtained with the first treatment. A significant improvement of forced expiratory volume in 1 second (p < 0.05), forced vital capacity (p < 0.05), residual volume (p < 0.05), 6-minute walking test (p < 0.05), and St. George respiratory questionnaire (p < 0.02) was achieved after the second procedure. These results were maintained during follow-up. There was no significant difference regarding the changes of forced expiratory volume in 1 second (p = 0.4), forced vital capacity (p = 0.08), residual volume (p = 0.9), 6-minute walking test (p = 0.3), and St. George respiratory questionnaire (p = 0.1) between the bilateral and unilateral groups.
  
  
  CONCLUSIONS
  A sequential bilateral approach seems to be a valid strategy to improve respiratory function in patients with bilateral heterogeneous emphysema who have lost the benefits obtained with the first procedure.
authors.affiliation: Division of Thoracic Surgery Unit, Faculty of Medicine, Second University of Naples, Naples, Italy. Electronic address: alfonso.fiorelli@unina2.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.affiliation: Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Andrilli
authors.affiliation: Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Medicine and Pharmacy, University of Rome "Sapienza," Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Anile
authors.affiliation: Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Medicine and Pharmacy, University of Rome "Sapienza," Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Diso
authors.affiliation: Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Poggi
authors.affiliation: Pneumology and Rehabilitation Unit, Mauro Scarlato Hospital, Scafati, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Polverino
authors.affiliation: Endoscopic Air-Way Unit, ARNAS-Ospedale Civico Di Cristina Benfratelli, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Failla
authors.affiliation: Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Medicine and Pharmacy, University of Rome "Sapienza," Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.affiliation: Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome "Sapienza," Rome, Italy.
authors.forename: Erino Angelo
authors.initials: EA
authors.lastname: Rendina
authors.affiliation: Division of Thoracic Surgery Unit, Faculty of Medicine, Second University of Naples, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
mesh_terms: D000328:Adult; D000368:Aged; D001980:Bronchi / Q000000981:diagnostic imaging / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome