2012 annual meeting & cardiothoracic forum - Society for ...

ACTA-SCTS JOINT MEETING • Manchester Central Conference Centre
017 The Use of Endobronchial Valves for Lung Volume Reduction: An
Early Experience
Authors: O. Nawaytou; G. Elshafie; R. Sabit; M. Kornaszewska
University Hospital of Wales, United Kingdom
Objectives: Lung volume reduction surgery has been used successfully for the
management of patients with severe chronic obstructive pulmonary disease (COPD)
with improvements in quality of life and pulmonary function. This, however, comes at
a cost of high morbidity and mortality. Recently, several endoscopic procedures
have been developed for the same aim with early promising results. We present our
early experience with the use of unidirectional endobronchial valves (EBV) in an aim
to assess their safety and efficacy in patients with severe COPD.
Methods: Between February 2010 and October 2011, 9 patients with terminal
COPD were considered for EBV therapy. The mean FEV1 was 31.3±18.7% and the
mean RV was 166±123.8% predicted. Patients were assessed to a strict protocol
including full pulmonary function testing (PFT), high resolution CT,
ventilation/perfusion scan, echocardiogram and functional assessment. The last 5
patients also had cardiopulmonary excercise testing (CPET). All the procedures were
performed under awake sedation using flexible bronchoscopy and endobronchial
collateral ventilation assessment was employed in 7 patients. Patients will be
followed up with PFT and CPET at 6 months post discharge.
Results: 8 patients had an average of 2 Zephyr EBV (Pulmonx Corporation, CA)
successfully deployed. One patient was deemed unsuitable due to evidence of
cross ventilation. There was no in-hospital morbidity or mortality and mean hospital
stay was 1.5±1.2 days. At follow up, 3 patients developed conservatively treated
pneumonia and 2 required bronchoscopy. One patient developed worsenintg of
COPD and had the valves extracted. There were no episodes of migration or
haemoptysis. There was a postprocedural improvement in ECOG performance
status from 2.8±0.4 to 1.8±1.1 (p=0.04). CPET results are pending.
Conclusions: EBV insertion is a safe and feasible modality for the management of
severe COPD. Early results show a good subjective outcome which needs objective
validation.
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