Endoscopic lung volume reduction in patients with very low FEV1

Background: Even though endoscopic lung volume reduction (eLVR) with endobronchial valves (EBV) is an established therapy option for patients with severe emphysema, patients with a FEV1≤ 20% pred. are usually excluded from treatment. Methods: We retrospectively evaluated all patients treated in our department with EBV at an FEV1 ≤ 20% pred. regarding lung function and six-minute walking test (6-MWT). All patients underwent V/Q-Scan and were evaluated for collateral Ventilation to determine the target lobe. Results: We treated 18 patients; 15 were evaluated to date (aged 59.3 ± 6.8 years), eight were female. Mean (± SD) FEV1 before EBV implantation was 0.48 ± 0.13 L equal. 16.3 ± 2.7 % pred.; mean residual volume (RV) was 6.9 ± 1.5 L (326.0 ± 84.3 % pred.). Initial 6-MWT was 241 ± 70 m. Right upper lobe was treated 4-times, left upper lobe was treated 4-times, right lower lobe once, left lower lobe was treated 6-times. Four patients were treated bilaterally. After EBV treatment, mean FEV1 was 0.59 ± 0.11 L equal. 20.2 ± 2.6 % pred. (+23%); mean RV was 6.0 ± 1.8 L (275.6 ± 49.6 % pred; -13%). 6-MWT increased to 312 ± 98.5 m an (+29%). The pneumothorax rate was 20% (3/15 pat.); all pneumothoraces were treatable by chest tube only. 6/15 Patienten developed an atelectasis of the target lobe. Bilaterally treated patients benefitted from the treatment oft he 2nd side in the lung function tests. Discussion: At a low rate of complications, patients benefitted from EBV treatment despite initially low FEV1. Some patients improved remarkably, especially when they developed an atelectasis of the target lobe. The results of this retrospective analysis show that EBV treatment in patients with an FEV1 ≤ 20% pred. is feasible and safe.