Development of endoscopic valve therapy in patients with severe emphysema

Abstract

Introduction: Valve therapy in emphysema patients is performed since 2003. The VENT in 2010 showed statistically significant but not clinically relevant benefit. In the last years, patient selection was optimized increasing efficacy of valve therapy. Objective: Exploratory data analysis of patients receiving valve therapy. Methods: Evaluation of valve therapy by analysis of lung function, exercise capacity and radiological outcome from 2009-2013. Results: From 01/2009-12/2013, 382 patients underwent valve therapy. Overall, patients had statistically significant but clinically less relevant benefit (ΔVC 110ml, ΔFEV1 72ml, ΔRV -334ml, Δ6-MWT 37m, all p≤0.001) 3 months after valve therapy. During long-term follow-up, 58% had neither complete lobar atelectasis as maximum result nor pneumothorax as complication. A lobar atelectasis without pneumothorax was confirmed in 21% with increasing prevalence over the years. These patients had an excellent outcome (ΔVC 374ml, ΔFEV1 163ml, ΔRV -799ml, Δ6-MWT 52m, all p Conclusion: Today, valve therapy seems to induce clinically relevant benefit in a remarkable portion of treated patients most likely due to optimized patient selection.