A SINGLE-CENTER RETROSPECTIVE EVALUATION OF ENDOBRONCHIAL VALVES FOR LUNG VOLUME REDUCTION IN EMPHYSEMA PATIENTS

Abstract

SESSION TITLE: Wednesday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Lung volume reduction (LVR) surgery was shown to improve exercise tolerance in patients with emphysema. Criner et al. (LIBERATE) reinforced the utility of endobronchial valve (EBV) placement in patients with emphysema and hyperinflation to improve lung function. In this study we report our experience with bronchoscopic LVR following the commercial availability of EBVs. METHODS: Retrospective review of patients who were treated by bronchoscopic LVR over a 6-month period at a single site. Inclusion criteria were age ≥40 with emphysema and hyperinflation with Total Lung Capacity (TLC) >100% predicted and Residual Volume (RV) >150% predicted. Data gathered include baseline characteristics, 45-day spirometric data, and complications (pneumothorax, pleural effusion, COPD exacerbation, arrhythmia). The primary endpoint was post bronchodilator response FEV1 ≥ 15% increase from baseline. Secondary endpoints were TLC change, absolute change in FEV1, and complication rates of EBV. RESULTS: A total of 18 patients were treated during this period. The average age of the patients evaluated was 69 years-old. 61% of patients were female (11) and 88.9% were Caucasian (16). Baseline 6 minute walk distance (6MWD) was 251 meters. The average baseline RV was 4.54L (217% of predicted) and baseline post-bronchodilator FEV1 was 750mL (30.3% predicted). At the 45-day mark, our patients had a FEV1 increase of 79.2mL (increase of 3% predicted), 30.7% showed an improvement in FEV1 ≥15% from baseline. RV decrease was on average 190mL. Total lung volume reduction on average was 610mL with 75% exhibiting a decrease ≥350mL. Regarding complications, 38.9% of our patients did have post-procedure pneumothorax with 22.2% of the patients requiring partial or total EBV removal. 27.8% of patients did have post procedure COPD exacerbation requiring medical attention with 80% of those patients having COPD exacerbations in the first 45 days. One patient had a previous treatment with vapor to the contralateral lung and another had alpha 1 antitrypsin deficiency. Both had positive outcomes. CONCLUSIONS: At the 45-day point, our center’s experience provided similar positive results as the LIBERATE study. Additionally, our patients exhibited a comparable incidence of pneumothorax post EBV placement. To our knowledge, this is the first and largest published single center experience on EBV for lung volume reduction since the Food and Drug Administration (FDA) approved the device in June 2018. We anticipate similar positive results at the one-year mark. CLINICAL IMPLICATIONS: Heterogeneous and homogeneous emphysema can be effectively treated with endobronchial valves to improve patients’ lung function. DISCLOSURES: No relevant relationships by Raed Alalawi, source=Web Response No relevant relationships by Richard Sue, source=Web Response No relevant relationships by Steve Tseng, source=Web Response No relevant relationships by Leigha Vick, source=Web Response