Survival after endoscopic valve therapy in patients with severe emphysema

Abstract

Objectives: Endoscopic valve therapy leads to an improvement of lung function, exercise tolerance and quality of life in emphysema patients. Only few data exist on the long-term outcome. This analysis evaluated the impact of valve therapy on the survival of COPD patients. Methods: From 2005-2013, 449 patients (mean age 64 years, 54% male) with emphysema underwent valve therapy. Patients were followed for a mean time of 37.3±21.3 months. 128 patients (29%) developed complete lobar atelectasis, whereby 34 out of these also experienced pneumothorax; in 50 patients (11%) pneumothorax without lobar atelectasis and in 261 patients (58%) only target lobe volume reduction or no volume change were observed. Baseline of survival was set as the date of first valve implantation. Results: Patients with and without atelectasis showed similar characteristics. Baseline FEV 1 %, RV(l), TLC(l) and TLCO(%) were significantly better in the atelectasis group, however the difference was not clinically relevant (FEV 1 32±8% vs. 30±9%, RV 5.4±1.2L vs. 5.8±1.4L, TLC 7.9±1.6L vs. 8.2±1.7L, TLCO 32±12% vs. 30±11%; all p<0.05). Patients with lobar atelectasis had a significant survival benefit compared to patients without atelectasis (p=0.009; 5-year survival rate 63.5% vs. 43.9%). The advent of pneumothorax in 84 patients did not influence the survival (p=0.52). Conclusions: Lobar atelectasis following endoscopic valve therapy is associated with a survival benefit.