Bronchoscopic Lung Volume Reduction for End-Stage Emphysema Report on the First 98 Patients

Objectives: To report the first multicenter experience on the treatment of end-stage emphysema using an endobronchial valve (EBV) [Emphasys EBV; Emphasys Medical; Redwood City, CA]. Design: Retrospective analysis from prospective multicenter registry. Patients and interventions: This is a study of the use of EBVs in the treatment of end-stage emphysema at nine centers in seven countries. Ninety-eight patients with mean FEV1 of 0.9 ± 0.3 L (30.1 ± 10.7% of predicted) [± SD] and residual volume (RV) of 5.1 ± 1.3 L (244.3 ± 0.3% of predicted) were treated over a period of 20 months. Spirometry, plethysmography, and diffusing capacity of the lung for carbon monoxide (Dlco) and exercise tolerance testing were performed at 30 days and 90 days after the procedure. Results: RV decreased by 4.9 ± 17.4% (p = 0.025), FEV1 increased by 10.7 ± 26.2% (p = 0.007), FVC increased by 9.0 ± 23.9% (p = 0.024), and 6-min walk distance increased by 23.0 + 55.3% (p = 0.001). There was a trend toward improvement in Dlco, but this did not reach statistical significance (17.2 ± 52.0%, p = 0.063). Patients treated unilaterally showed a trend toward greater improvement than those treated bilaterally. A similar trend toward improvement was observed in patients who had one entire lobe treated compared to those with just one or two bronchopulmonary segments treated. Eight patients (8.2%) had serious complications in the first 90 days, including one death (1.0%). Conclusion: This multicenter analysis confirms that improvement in pulmonary function and exercise tolerance can be achieved in emphysematous patients using EBVs. Future efforts should be directed to determining how to select those patients who would benefit most from this procedure and the best endobronchial treatment strategy.