Bronchial Valve Research Articles

Bronchial Valve Approved for Postoperative Air Leaks in Lung

Bronchial Valve Approved for Postoperative Air Leaks in Lung

Computed tomography assessment of lung volume changes after bronchial valve treatment

The aim of the present study was to correlate clinical outcome measures following treatment with bronchial valves with regional lung volume. Computed tomography (CT) scan data from 57 subjects with severe emphysema were obtained from nine North American clinical trial sites. IBV(R) Valves (Spiration, Inc., Redmond, WA, USA) were placed to occlude segmental and subsegmental bronchi in right and left upper lobes using a flexible bronchoscope. Subjects completed a St George's Respiratory Questionnaire (SGRQ), pulmonary function test (PFT) and exercise capacity test. CT scans were analysed at baseline and at 1, 3 or 6 months after treatment to measure total and lobar lung density, volume and mass. Total lung volumes measured using CT were strongly correlated with PFT and did not change with treatment. However, the treated upper lobes significantly decreased in volume in 88% of the observations, by mean+/-sd 335+/-444 mL, or a decrease of 10.2% in the 6 month data. The untreated lobes had an 11.6% increase in volume. Changes in regional lung volume were associated with clinically meaningful improvements in SGRQ (-8.95+/-16.22), but not clinically meaningful PFT changes. The significant health status improvements reported by subjects following bilateral bronchial valve treatment are associated with regional lung volume changes and interlobar shift measured using computed tomography.

EXPERIENCE WITH BRONCHIAL VALVE REMOVAL

PURPOSE: Medical devices are generally permanent implants but not all patients will be responsive to device treatment, and some patients may have complications requiring implant removal. It is desirable that a new airway device be removable. We review here details about removal of bronchial valves.

Endobronchial Volume Reduction: A Myth or a Marvel?

Recently, several techniques and devices have been suggested for achieving endobronchial volume reduction in patients with emphysema. The proposed devices include bronchial blockers, bronchial valves, glues, biomodulators, and stents for bronchial fenestration; all could be positioned only with flexible bronchoscopy. The current available evidence on safety and efficacy for these methods is based on animal studies and patient case series at best; therefore, all the results should be seen with caution. However, the preliminary work reviewed here suggests that most of the proposed techniques can work, and seem to be safer than surgical volume reduction. We do not yet have a proven, widely applicable endobronchial palliative treatment for severe emphysema, but we have a rapidly growing area of new research in interventional pneumology with preliminary results that challenge traditional medical thinking.

New and Emerging Minimally Invasive Techniques for Lung Volume Reduction

Lung volume reduction surgery (LVRS) has been shown to improve pulmonary function, exercise capacity, quality of life, and survival in selected patients with heterogeneous emphysema. However, LVRS is a major surgical procedure with potential morbidity and mortality. Minimally invasive techniques are emerging to achieve lung volume reduction without open thoracotomy. Devices and techniques under study include one-way bronchial valves inserted via fiberoptic bronchoscopy to promote atelectasis in emphysematous lung, promotion of focal atelectasis and fibrosis by bronchoscopic injection of polymers into emphysematous regions of lung, bronchopulmonary fenestrations to enhance expiratory flow, and thoracoscopic plication or compression of emphysematous lung. The goal of all of these procedures is to replicate the benefit of LVRS without the trauma, risks, and extended recovery of open LVRS. Refinement and application of these techniques will allow patients with emphysema and their physicians and surgeons to choose from a number of viable options for lung volume reduction.