Patient selection and efficacy of valve bronchoscopic lung volume reduction (BLVR) in emphysema

Abstract

BLVR has been proposed as an alternative to lung volume reduction surgery in patients with severe emphysema (TomaTP et al Lancet 2003; 361:931-3). There is agreement that for bronchial valves to work, fissure integrity is needed as it is associated with lobar volumetric changes which predicts efficacy of BLVR (VenutaF et al Ann Thorac Surg 2005;79:411-416). Two methods are available to evaluate fissure integrity: HRCT with direct observation of fissures and Chartis to directly assess the absence of collateral ventilation as the functional result of fissure integrity. We evaluated the response of 11 consecutive patients (FEV1 0,80L±0,25; RV 5,05L±1.3) with severe heterogeneous emphysema and complete fissure based on Chartis and CT scan analysis. Patients had valves (Olympus SVS) placed in the most diseased lobe with complete fissure (Chartis). Fissure completeness was also evaluated through quantitative CT (SeleCT by VIDA, Olympus). Lung function (FEV1, RV) showed significant improvement at 6 months. Follow up CT at 3 months showed significant volume reduction in the target lobe and a 62% responder rate as defined as ≥ 350ml volume reduction