Long-term follow up after endoscopic valve therapy in patients with severe emphysema

Abstract

Background and objective: Endoscopic valve therapy is a treatment modality in patients with advanced emphysema and absent interlobar collateral ventilation (CV). So far, long-term outcome following valve implantation has been insufficiently evaluated. The aim of this study was to investigate the real-world efficacy of this interventional therapy over 3 years. Methods: From 2006 to 2013, 256 patients with severe emphysema in whom absent CV was confirmed underwent valve therapy. The 3-year effectiveness was evaluated by pulmonary function testing (VC, FEV1, RV, TLC), 6-minute-walk test (6-MWT) and dyspnea questionnaire (mMRC). Long-term outcome was also assessed according to the radiological outcome following valve placement. Results: Of 256 patients treated with valves, 220, 200, 187, 100 and 66 patients completed the 3-month, 6-month, 1-year, 2-year and 3-year follow-up (FU) visit, respectively. All lung function parameters, 6-MWT and mMRC were significantly improved at 3- and 6-month FU. At 1-year FU, patients still experienced a significant improvement of all outcome parameters expect VC (L) and TLC (%). At 2 years, RV (L and %) and TLC (L and %) remained significantly improved compared to baseline. Three years after valve therapy, sustained significant improvement in mMRC was observed and the proportion of patients achieving a minimal clinically important difference from baseline in RV and 6-MWT was still 71% and 46%, respectively. Overall, patients with complete lobar atelectasis exhibited superior treatment outcome with 3-year responder rates to FEV1, RV and 6-MWT of 10%, 79% and 53%, respectively. Conclusions: Patients treated by valves experienced clinical improvement over 1 year following valve therapy. Afterwards, clinical benefit gradually declines more likely due to COPD progression. The reviews of this paper are available via the supplemental material section.

Endobronchial valve therapy for severe emphysema: an overview of valve-related complications and its management

“…In case the desired complete atelectasis is still visible on the CT scan, the decline of the patients' condition may possibly be explained as a result of either ongoing progression of COPD, or due to compensatory expansion of the adjacent lobe [32].…”

Lung Volume Reduction in Pulmonary Emphysema

“…In a series of 256 patients whose absent CV was determined radiologically or using the Chartis, 3-year responder rates for FEV1 > 100 mL, RV > À430 mL and 6MWD > 26 m were relatively high at 10, 79, and 53%, respectively. 42 EBV treatment has a favorable incremental cost-effectiveness ratio (ICER) of approximately $43,000 per QALY at 5 years and $23,000 per QALY at 10 years. 43,44 In line with this, the LIBERATE trial suggested reduced health care burden with a lower frequency of COPD exacerbations requiring hospitalization in the longer term.…”

Bronchoscopic interventions for emphysema: Current status

“…More recently, Gompelmann et al retrospectively investigated the durability of the benefit of EBV in 256 patients. [ 30 ] In this study, only patients who had the absence of collateral ventilation (CV) were included in the analysis. Due to losses to follow-up and death, only half of patients completed a 1-year assessment and a quarter at 3 years.…”

“…Despite clinical benefit sustained within the 1 st year, the marked decline is notable beyond this point, and only a few parameters remained statistically significant compared to baseline 3 years later. [ 30 ] Although the decline may be due to the natural progression of the COPD, comparison with matched controls in a prospective study is imperative before conclusions can be drawn. [ 30 ] Strikingly, despite stringent patient selection, up to 25% of patients required permanent removal of all valves during the first 3 years, of which more than half were due to the lack of clinical benefit.…”