Endobronchial valves for bilateral endoscopic lung volume reduction

Background: Endoscopic lung volumen reduction (eLVR) with endobronchial valves (EBV) is an established therapy option for patients with severe emphysema. Patients are mostly treated unilaterally, rarely EBV is performed bilaterally. Methods: We retrospectively evaluated all patients treated in our department with EBV bilaterlally regarding lung function and six-minute walking test (6-MWT). All patients underwent V/Q-Scan and were evaluated for collateral ventilation using Chartis measurement to determine the target lobe. Results: Up to now, we treated 8 patients with valves only (aged 59.3 ± 6.8 years), bilaterally (3/8 female). Patients recieving hybrid procedures (combination of valves and coils) were not included. Mean [± SD] FEV 1 prior to the first EBV implantation was 22.6 ± 9.8 % pred. with a residual volume (RV) of 308.3 ± 53.2 % pred. The 6-MWT was 246 ± 88 m. Mean FEV 1 prior to the 2nd EBV implantation was betrug 26.1 ± 8.3 % pred. (+15%) at a RV of 276.1 ± 41.8 % pred. (-10%). 6-MWT was 338.5 ± 75 m (+43%). After bilateral treatment, mean FEV 1 was 28.4 ± 8.1 % pred. (+23%); RV was 252.4 ± 48 % pred.; -18%). Die 6-MWT was relatively constant at 327 ± 126 m (+42% from baseline). The pneumothorax rate was 32 % (5/16 procedures); all pneumothoraces were treatable by chest tube only. After the first treatment, one patient developed pneumonia of the non-treated side. Discussion: At a low rate of complications patients benefitted from uni- and later bilateral eLVR with EBV. Bilateral eLVR with EBV could further improve the results of the first treatment. Bilateral eLVR with EBV is feasible and safe.