International Journal of COPD (May 2023)

Endobronchial Valve Replacements in Patients with Advanced Emphysema After Endoscopic Lung Volume Reduction

  • Brock JM,
  • Schuster PU,
  • Böhmker F,
  • Eberhardt R,
  • Gompelmann D,
  • Kontogianni K,
  • Trudzinski F,
  • Benjamin N,
  • Herth F

Journal volume & issue
Vol. Volume 18
pp. 933 – 943

Abstract

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Judith Maria Brock,1,2 Paul Ulrich Schuster,3 Felix Böhmker,3 Ralf Eberhardt,4 Daniela Gompelmann,5 Konstantina Kontogianni,1,2 Franziska Trudzinski,1,2 Nicola Benjamin,1 Felix Herth1,2 1Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany; 2Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; 3Medical Faculty, University of Heidelberg, Heidelberg, Germany; 4Department of Pneumology and Intensive Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany; 5Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, AustriaCorrespondence: Judith Maria Brock, Department of Pneumology and Critical Care Medicine, Thoraxklinik Heidelberg, University Hospital of Heidelberg, Röntgenstraße 1, Heidelberg, 69126, Germany, Tel +49 6221-3968256, Email [email protected]: Up to 41% of patients with endobronchial valve implantation need revision bronchoscopies and valve replacements most likely due to valve dysfunction or lack of benefit. So far, no data is available whether valve replacements lead to the desired lobar volume reduction and therapy benefit.Patients and Methods: We conducted a single-center retrospective analysis of patients with endobronchial valve implantation and at least one valve replacement. Indications and number of revision bronchoscopies and valve replacements were evaluated. Therapy benefit regarding lung function and exercise capacity as well as development of complete lobar atelectasis was investigated and possible predictors identified.Results: We identified 73 patients with 1– 12 revision bronchoscopies and 1– 5 valve replacements. The main indication for revision bronchoscopy in this group was lack of therapy benefit (44.2%). Lung function and exercise capacity showed improvements in about one-third of patients even years after the initial implantation. A total of 26% of all patients showed a complete lobar atelectasis at the end of the observation period, 56.2% had developed lung volume reduction. The logistic regression revealed the development of a previous complete lobar atelectasis as predictor for a complete lobar atelectasis at final follow-up. Oral cortisone long-term therapy was also shown as predictive factor. The probability for a final complete lobar atelectasis was 69.2% if a lobar atelectasis had developed before.Conclusion: Valve replacements are more likely to be beneficial in patients who develop a re-aeration of a previous lobar atelectasis following valve implantation. Every decision for revision bronchoscopy must be taken carefully.Keywords: endobronchial lung volume reduction, endobronchial valves, valve replacement, revision bronchoscopy, COPD

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