Long-term outcomes from bronchoscopic lung volume reduction using a bronchial prosthesis

• Published in: Respirology (Carlton, Vic.) Vol. 16; no. 1; pp. 167 - 173
• Main Authors: KOTECHA, Sakhee, WESTALL, Glen P, HOLSWORTH, Lynda, PHAM, Alan, WILLIAMS, Trevor J, SNELL, Greg I
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.01.2011
• Subjects: Aged; Bronchi - physiopathology; Bronchi - surgery; Bronchoscopy; emphysema; endoscopic valves; Female; Humans; lung function; Lung Transplantation; lung volume reduction; Male; Middle Aged; Pneumonectomy - methods; Prostheses and Implants; Pulmonary Emphysema - pathology; Pulmonary Emphysema - surgery; Respiratory Function Tests; Retrospective Studies; safety; Treatment Outcome
• ISSN: 1323-7799; 1440-1843
• DOI: 10.1111/j.1440-1843.2010.01896.x

ABSTRACT Background and objective:  We evaluated long‐term safety and lung function outcomes in a cohort of patients with severe upper‐zone heterogeneous emphysema who underwent bronchoscopic lung volume reduction (BLVR) performed with the Emphasys one‐way valve. Methods:  A retrospective cohort study was undertaken to assess long‐term outcomes in 23 consecutive patients who underwent upper lobe BLVR between July 2001 and November 2003 as part of a first‐in‐humans study. Long‐term follow up (>12 months) was available in 16/23 patients (median duration of follow up 64 months (range 15–90 months)). Both unilateral (n = 4) and bilateral (n = 12) BLVR procedures were performed with a mean of 6 (range 3–11) valves being inserted. Changes in pulmonary function tests were assessed longitudinally following the procedure. Results:  13/16 and 11/16 patients showed post‐procedure improvements in FEV1 and DLCO, respectively. However, early improvements in pulmonary function were not sustained with only 6/16 patients still showing improved lung function at the end of follow up. There were no significant improvements in other indices of pulmonary function. Three patients, in the absence of clinical benefit, proceeded to lung transplantation at 15, 16 and 44 months post BLVR. Four patients died during the course of the study at 27, 29, 39 and 50 months post procedure. Conclusions:  BLVR with the Emphasys one‐way valve has an acceptable safety profile and in select patients may achieve long‐term sustained improvements in pulmonary function. While prior studies have shown short‐term improvements in lung function following bronchoscopic lung volume reduction, we now provide long‐term data on a cohort of patients with severe emphysema treated with one‐way valves. Sustained improvements in lung function were more likely to be seen in patients with greater hyperinflation at baseline.