Endobronchial Valves : First french multicenter retrospective study on the 2 steps approach

Background: As the endobronchial valves (EBV) were successfully developed as treatment for severe emphysema, its main complication, pneumothorax, remained an important concern (prevalence reported as 26% in a recent published meta-analysis). Objective: To assess whether the placement of Zephyr endobronchial valves throughout 2 procedures instead of 1 minor the frequency of pneumothorax without lowering its benefits. Methods: This retrospective study was conducted in 15 pulmonology departments in France. All patients met the inclusion criteria defined by the expert panel on the Endoscopic Lung Volume Reduction (ELVR), updated in 2019. During the first procedure, all but the most proximal sub-segment of the targeted lobe were occluded. One month after, EBV were placed in the last subsegment. All patients were evaluated before and 3 months after the second procedure. Results: Between March 2018 and December 2019, 95 patients received EBV treatment. 12 patients (12.5%) presented a pneumothorax (3 after the 1st and 9 after the 2nd procedure). Beside pneumothorax, the main adverse event were exacerbation (21%) and pneumonia (5%). No death was reported. Significant improvements were found for FEV1 (14.6 ± 25.3%), RV (- 0.69 ± 2.1L), 6MWT (34.8 ± 45.9m), BODE Score (-1.41 ± 1.41pts), and mMRC scale (-0.85 ± 0.7pts). Our results are similar to the ones previously published with the usual 1 time procedure (Table 1). Conclusion: Placing EBV during 2 procedures instead of one led to a significant decrease of post treatment pneumothoraces. It did not increased the rate of other complications. It does not seem to alter the benefits of this therapy for severe emphysema.