Endoscopic Lung Volume Reduction Using Endobronchial Valves in Patients with Severe Emphysema and Very Low FEV1.
BACKGROUND
Patients with a forced expiratory volume in 1 s (FEV1) below 20% of the predicted normal values (pred.) and either homogeneous emphysema or low diffusing capacity for carbon monoxide (DLCO) have a high risk for adverse events including death when undergoing surgical lung volume reduction.


OBJECTIVE
We hypothesized that selected patients can benefit from endoscopic lung volume reduction (eLVR) despite a very low FEV1.


METHODS
This study is a retrospective analysis of consecutive patients with severe airflow obstruction, an FEV1 ≤20% of pred., and low DLCO who were treated by eLVR with endobronchial valves (EBV) between June 2012 and January 2015. Pre- and postinterventional lung function parameters, the 6-min walking test (6-MWT) distance, adverse events, and follow-up were recorded.


RESULTS
In 20 patients, there was an overall improvement in lung function with an increase in FEV1 (16.97-21.03% of pred.) and a decrease in residual volume (322-270% of pred.) and total lung capacity (144-129.06% of pred.). The 6-MWT distance improved (from 239 ± 77 to 267± 97 m overall, and from 184 ± 50 to 237 ± 101 m if patients developed an atelectasis of the target lobe). Pneumothorax occurred in 5 of the 20 patients (25%). 30-day mortality was 0%, and all patients survived to discharge.


CONCLUSIONS
The patients benefitted moderately from EBV treatment despite an initially low FEV1. Some patients improved remarkably. EBV treatment in patients with an FEV1 ≤20% of pred. is generally feasible and safe. The greatest risk is pneumothorax with prolonged chest tube duration.
Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center, Homburg, Germany.
Franziska C
FC
Trudzinski
Anna J
AJ
Höink
Daniela
D
Leppert
Sebastian
S
Fähndrich
Heinrike
H
Wilkens
Thomas P
TP
Graeter
Frank
F
Langer
Robert
R
Bals
Peter
P
Minko
Philipp M
PM
Lepper
D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011030:Pneumothorax / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D019919:Prosthesis Implantation / Q000379:methods*; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D012115:Residual Volume; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014109:Total Lung Capacity; D016896:Treatment Outcome; D000070857:Walk Test