Predictors of efficacy for endobronchial valves in bronchoscopic lung volume reduction

Abstract

Over the last several years, numerous trials have been carried out to check the efficacy of one-way valves in the management of advanced emphysema. While the design of the valves has not altered much, by selectively studying these valves in a select group of participants, such as those with and without intact fissures (FIþ and FIÀ), and by using different procedural techniques, our understanding of the valves has evolved. In this metaanalysis, we sought to study the effect of these factors on the efficacy of one-way valves. From PubMed and Embase, we included only those studies that provided separate data on fissure integrity or collateral ventilation. Our study outcomes included the mean change in forced expiratory volume in first second (FEV 1 ), 6-minute walk distance (6MWD) and the St George's Respiratory Questionnaire (SGRQ). In the FIþ subgroup of participants, the pooled standardized mean difference in FEV 1 , 6MWD, and SGRQ were 0.50 (95% confidence interval (CI): 0.34 to 0.67), p 0.001, 0.29 (95% CI: 0.13 to 0.45), p 0.001 and À6.02 (95% CI: À12.12 to 0.06), p ¼ 0.05, respectively. In comparison, these results were superior to the FIÀ subgroup of participants. A separate analysis of the FIþ subgroup based on lobar occlusion versus nonlobar occlusion favored the former for superior efficacy. The preliminary findings of our meta-analysis confirm that one-way valves perform better in a select group of patients who show intact fissures on lung imaging pretreatment and in those who achieve lobar occlusion.

A Long-Term Follow-Up Investigation of Endobronchial Valves in Emphysema (the LIVE Study): Study Protocol and Six-Month Interim Analysis Results of a Prospective Five-Year Observational Study

“…While clinical evidence from RCTs, controlled trials and case series [13,14,15,16,17,18,19,20,21,22,23] demonstrates that by achieving lobar occlusion in the absence of CV, significant lung volume reduction can be obtained with associated significant clinical responses in severe emphysema patients, the efficacy/safety profile of the Zephyr® valve has not been reported in a large-scale observational study under conditions of daily clinical practice. We now report the study design and interim clinical results of the LIVE Study which was designed to gather safety and effectiveness data on EBV therapy in the real-world setting.…”

Fluorescence Diagnostics and Photodynamic Therapy In Cancer

“…In this system, woven is illuminated by two narrow bands of light waves. A band in the range from 390 nm to 445 nm (blue band) which is absorbed by capillaries of the surface mucosa layer and a band in the range from 530 nm to 550 nm (green band) which is absorbed by hemoglobin in deeper submucosal thick blood vessels (34). Research conducted using this technique confirms its good effectiveness in differentiating normal from cancerous tissues (35)(36)(37).…”

Update on Nonsurgical Lung Volume Reduction Procedures

“…Heterogeneity can be defined, for instance, as the difference in the quantitative emphysema score between the targeted lobe and the adjacent ipsilateral nontargeted lobe. A key anatomical feature associated with lung deflation, therefore, is a “complete” fissure as suggested by the absence of a parenchymal bridge connecting the lobes for >10% of the fissure [ 2 ]. When both complete fissure and lobar occlusion are present, substantial increments in FEV 1 (up to 26%, on average) have been reported in 6 months and sustained at 12 months.…”