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

Abstract

Purpose

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

Abbreviations

6-MWD, 6-minute-walk difference; BMI, body mass index; CAT, COPD assessment test; COPD, Chronic Obstructive Pulmonary Disease; DLCO SB, transfer factor for carbon monoxide; DLCO/VA, DLOC divided by the alveolar volume; EBV, endobronchial valves; ELVR, Endoscopic Lung Volume Reduction; FEV₁, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; IBV, intrabronchial valves; ICS, inhaled corticosteroid; LABA, long-acting-beta-agonist; LAMA, long-acting-muscarinic antagonist; LLL, left lower lobe; LUL, left upper lobe; LVRS, Lung volume reduction surgery; MCID, minimal clinically important difference; MDCT, multi-detector computed tomography; mMRC, modified Medical Research Council; RV, residual volume; TLC, total lung capacity; VC, vital capacity; Yacta, yet another CT scan analyzer.

Data Sharing Statement

The data that support the findings of this study are available in the Supplementary Materials of this article.

Ethics Approval Declaration

The study protocol was reviewed and approved by the institute’s ethics committee of Heidelberg (S-304/2021). All patients gave written informed consent for the scientific use of their medical records. This study complies with the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Judith Brock has received honoraria and consultation fees from Boehringer Ingelheim, Astra Zeneca, streamed up!, Intuitive Surgical Inc, Berlin Chemie, outside the submitted work. Paul Ulrich Schuster, Felix Böhmker, and Nicola Benjamin have no conflicts of interest to report for this work. Prof. Dr. Ralf Eberhardt reports honoraria or payment for lectures and presentations from Broncus, Olympus, Pentax, Pulmonx, Astra Zeneca. He joins the data safety monitoring board for Intuitive Surgical Inc, outside the submitted work. Prof. Dr. Daniela Gompelmann reports fees for lectures and travel from Pulmonx, Chiesi, Boehringer Ingelheim, Astra Zeneca, Berlin Chemie, Erbe, Novartis, Olympus, outside the submitted work. Konstantina Kontogianni has received honoraria for lectures from Berlin-Chemie, Astra Zeneca and Boston Scientific, outside the submitted work. Franziska Trudzinski has received honoraria for lectures from Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Grifols, Novartis, CSL Behring. She participates in an Advisory Board for CSL Behring, GlaxoSmithKline and Boehringer Ingelheim, outside the submitted work. Felix Herth reports Research Support from Olympus Medical, Pulmonx, Broncus, Uptake Medical, Roche Diagnostics, BMBF, DFG, EU, Klaus-Tschira Stiftung, BMG; Lecturing honoraria from Pulmonx, Uptake Medical, Roche Diagnostics, Astra Zeneca, Boehringer Ingelheim, Novartis, Berlin Chemie, Chiesi, Medupdate, Erbe, GSK and consulting activities for Olympus Medical, Pulmonx, Broncus – Uptake Medical, Roche Diagnostics, Astra Zeneca, J&J, Karger, LÄK, Boston Scientific, Dinova, Nanovation, Free Flow Medical, Erbe, outside the submitted work.

Additional information

Funding

There were no funding sources for this project.