Implementation of Bronchoscopic Lung Volume Reduction Using One-Way Endobronchial Valves: A Retrospective Single-Centre Cohort Study

R. Posthuma*, A.W. Vaes, K.H.M. Walraven, P.S. Nia, J.U. Schreiber, H.A. Gietema, G. Wesseling, E.F.M. Wouters, L.E.G.W. Vanfleteren

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program. Objectives: In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes. Method: A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV1), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample t tests were performed to compare means before and after intervention. Results: Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (n = 2) or lack of benefit (n = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change +/- SD in CAT -4 +/- 6 points, FEV1 +190 +/- 140 mL, RV -770 +/- 790 mL, and +37 +/- 65 m on the 6MWT (all p < 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. Conclusion: Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.
Original languageEnglish
Pages (from-to)476-484
Number of pages9
JournalRespiration
Volume101
Issue number5
Early online date22 Dec 2021
DOIs
Publication statusPublished - May 2022

Keywords

  • Bronchoscopic lung volume reduction
  • Intervention
  • Interventional bronchoscopy
  • Emphysema
  • MINIMAL IMPORTANT DIFFERENCE
  • FOLLOW-UP
  • EMPHYSEMA
  • PNEUMOTHORAX
  • SURGERY
  • THERAPY
  • DENSITY

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