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Background <p>In COPD patients with severe right-sided emphysema, complete major and incomplete minor fissure, implantation of one-way valves in both the right upper (RUL) and middle lobes (ML) is a possible approach for endoscopic lung volume reduction. The aim of this retrospective analysis was to evaluate the response to therapy and the complication rate at 90 days (90d-FU) after combined RUL-ML valve implantation.</p> Methods <p>This retrospective, monocentric study included all patients from the Thoraxklinik Heidelberg who underwent RUL-ML valve treatment between 2012 and 2023 with available follow-up data. Quantitative chest imaging, lung function, 6-minute walking distance (6-MWD), complications and indications for re-bronchoscopies until 90d-FU were analysed.</p> Results <p>28 patients underwent combined RUL-ML valve treatment, predominantly sequentially (92.86%, <i>n</i> = 26/28). Neither lung function nor 6MWD improved significantly in the overall cohort. However, in the subgroup with heterogeneous emphysema (71.4%, <i>n</i> = 20/28), FEV1 (Δ = 116.00 mL ± 195.77 mL, <i>p</i> &lt; 0.05) and 6-MWD (Δ = 50.23 ± 69.10&#xa0;m, <i>p</i> &lt; 0.05) increased significantly at 90d-FU. Consistent with this, the baseline difference in emphysema volume between the RUL + ML and the right lower lobe correlated significantly with the increase in FEV1 at 90d-FU (<i>R</i> = 0.74, <i>p</i> &lt; 0.001). Pneumothorax occurred in 5 cases in 4 patients (14.3%) following ML treatment. Severe pneumonia and/or COPD exacerbations occurred in 32.1% (9/28) of patients.</p> Conclusions <p>Although only studied in a small cohort, our data suggest that combined RUL and ML valve implantation appears to be a promising interventional treatment strategy in patients with severe heterogenous RUL and ML emphysema.</p>

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Outcome and safety 90 days after combined airway valve treatment of the right upper and middle lobes in patients with severe pulmonary emphysema

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月6日

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  • A. Susanne Dittrich,
  • Cosimo Carlo De Pace,
  • Judith Maria Brock,
  • Franziska Trudzinski,
  • Claus Peter Heussel,
  • Ralf Eberhardt,
  • Felix J. F. Herth,
  • Konstantina Kontogianni

摘要

Background

In COPD patients with severe right-sided emphysema, complete major and incomplete minor fissure, implantation of one-way valves in both the right upper (RUL) and middle lobes (ML) is a possible approach for endoscopic lung volume reduction. The aim of this retrospective analysis was to evaluate the response to therapy and the complication rate at 90 days (90d-FU) after combined RUL-ML valve implantation.

Methods

This retrospective, monocentric study included all patients from the Thoraxklinik Heidelberg who underwent RUL-ML valve treatment between 2012 and 2023 with available follow-up data. Quantitative chest imaging, lung function, 6-minute walking distance (6-MWD), complications and indications for re-bronchoscopies until 90d-FU were analysed.

Results

28 patients underwent combined RUL-ML valve treatment, predominantly sequentially (92.86%, n = 26/28). Neither lung function nor 6MWD improved significantly in the overall cohort. However, in the subgroup with heterogeneous emphysema (71.4%, n = 20/28), FEV1 (Δ = 116.00 mL ± 195.77 mL, p < 0.05) and 6-MWD (Δ = 50.23 ± 69.10 m, p < 0.05) increased significantly at 90d-FU. Consistent with this, the baseline difference in emphysema volume between the RUL + ML and the right lower lobe correlated significantly with the increase in FEV1 at 90d-FU (R = 0.74, p < 0.001). Pneumothorax occurred in 5 cases in 4 patients (14.3%) following ML treatment. Severe pneumonia and/or COPD exacerbations occurred in 32.1% (9/28) of patients.

Conclusions

Although only studied in a small cohort, our data suggest that combined RUL and ML valve implantation appears to be a promising interventional treatment strategy in patients with severe heterogenous RUL and ML emphysema.