Clinical outcomes and quantitative CT analysis after bronchoscopic lung volume reduction using valves for advanced emphysema

Abstract

Background: Bronchoscopic lung volume reduction (BLVR) using Zephyr endobronchial valve (EBV) and intrabronchial valve (IBV) has been shown to improve lung function and exercise capacity in severe emphysema. However, changes in airway structures and whether these are related to the clinical improvements remain unclear.Methods: A retrospective study was performed on patients treated with BLVR. We compared changes in 2nd-, 3rd-, and 4th-generation bronchial structures after therapy, including wall thickness (WT), percentage of wall thickness (WT%), intraluminal area (LA), wall area (WA), and WA%. Responder and non-responder subgroup analysis according to minimum clinically important difference (MCID) which was defined as an improvement of 15% in forced expiratory volume in 1 s (FEV 1 ) and 26 m in 6 min walk distance (6MWD) was conducted.Results: Of the 19 patients, 11 were treated with EBV and 8 with IBV. In ipsilateral non-target lobes, WT% decreased significantly in 3rd-generation bronchi at 1 month, 3, and 6 months, as well as their WA% at 1 month and 6 months. Non-responders, who were unable to achieve MCID, showed no consistent bronchial wall changes. And their LA of 3rd-generation bronchi decreased especially at 1 month. After BLVR, the target lobe volume decreased significantly until 12 months of follow-up. The volume of ipsilateral lobes could increase correspondingly and achieve the best improvements at 6 months. The contralateral lung volume showed slight amelioration but there was no statistical significance.Conclusions: Both airway structures and lung volumes showed changes after BLVR. The 3rd-and 4thbronchial walls tend to be thinner, which were consistent with clinical improvements. Further studies are needed to prove this conclusion and find detect potential mechanics.

Endobronchial valves for emphysema and persistent air-leak: 10-year experience in an Asian country

“…In Japan, BLVR techniques with autologous blood, thrombin or Spigot have been reported through case series or reports [ 24 , 25 ], and relatively common methods such as EBV or coil have not been published. In China, experimental devices including flap or occlude have been studied [ 26 , 27 ], alongside case reports [ 28 , 29 ] and single-arm studies evaluating the efficacy of endobronchial valve [ 30 , 31 ], showing improvements in lung function and exercise capacity. In Korea, after the early studies reporting the clinical outcomes of EBV insertion [ 9 , 10 ], studies on the improvement of ventilation-perfusion mismatch with BLVR and the utility of fissure integrity analyzed through quantitative CT to select EBV insertion sites were published [ 32 , 33 ].…”

A preclinical animal study to evaluate the operability and safety of domestic one-way endobronchial valves

“…EBV, as an implantable device designed to allow secretions and gas to be discharged from lung tissue but prevent gas from entering lung tissue at the distal end of the valve, eventually leads to atelectasis of the treated lobe, provided if the absence of collateral ventilation between the treated lobe with EBV and the untreated ipsilateral lobe (20). Based on positive outcomes of the treatment on symptoms, pulmonary function, exercise capacity and quality of life in multiple randomised controlled trials (2), EBV treatment has gained popularity over the course of the last decade and currently served as the most widely used lung volume reduction method for select patients with severe emphysema (21)(22)(23)(24).…”