Sequential Bilateral Bronchoscopic Lung Volume Reduction With One-Way Valves for Heterogeneous Emphysema

Abstract

Clinical benefits of bronchoscopic lung volume reduction with one-way endobronchial valves have been reported for heterogeneous emphysema after unilateral treatment. We assessed the potential role of contralateral treatment to prolong the benefits obtained with the first procedure. This was a retrospective multicenter study including consecutive patients with heterogeneous emphysema undergoing bronchoscopic valves deployment during the last 4 years. Patients were split into two groups depending on the procedure (unilateral versus bilateral). The intergroup differences were evaluated to assess the viability, effectiveness, and safety of the bilateral procedure. Forty-nine patients were enrolled. Of these, 14 (28%) had a sequential bilateral procedure mainly due to loss of the clinical benefits obtained with the first treatment. A significant improvement of forced expiratory volume in 1 second (p < 0.05), forced vital capacity (p<0.05), residual volume (p < 0.05), 6-minute walking test (p< 0.05), and St. George respiratory questionnaire (p< 0.02) was achieved after the second procedure. These results were maintained during follow-up. There was nosignificant difference regarding the changes of forced expiratory volume in 1 second (p= 0.4), forced vital capacity (p= 0.08), residual volume (p= 0.9), 6-minute walking test (p= 0.3), and St. George respiratory questionnaire (p= 0.1) between the bilateral and unilateral groups. A sequential bilateral approach seems to be a valid strategy to improve respiratory function in patients with bilateral heterogeneous emphysema who have lost the benefits obtained with the first procedure.