Optimizing clinical outcomes for bronchoscopic lung volume reduction with Zephyr® valves - 20/05/24

Doi : 10.1016/j.rmed.2024.107639

T. David Koster ^a,^⁎ , Pallav L. Shah ^b,^c, Arschang Valipour ^d, Gerard J. Criner ^e, Felix J.F. Herth ^f, Richard Sue ^g, Douglas K. Hogarth ^h, Ralitza T. Martin ⁱ, Amit K. Mahajan ^j, Raed Alalawi ^k, Lisa Kopas ^l, Avi Cohen ^m, Douglas E. Wood ⁿ, Jonathan Kurman ^o, Narinder S. Shargill ^p, Mark Dransfield ^q, Dirk-Jan Slebos ^a, Michael Perch ^r,^s
^a Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
^b Royal Brompton Hospital, Department of Pulmonology, London, United Kingdom
^c National Heart & Lung Institute, Imperial College, London, United Kingdom
^d Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Health Care Group, Vienna, Austria
^e Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
^f Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
^g Advanced Lung Institute, Banner University Phoenix, Phoenix, AZ, USA
^h Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
ⁱ Piedmont/MD Anderson Healthcare Network System, Houston, TX, USA
^j Inova Health System, Fairfax, VA, USA
^k Banner Health, University of Arizona College of Medicine, Phoenix, AZ, USA
^l Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA
^m Henry Ford Health System, Detroit, MI, USA
ⁿ Department of Surgery, University of Washington, Seattle, WA, USA
^o Division of Pulmonary & Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
^p Pulmonx Corporation, Redwood City, CA, USA
^q Division of Pulmonary, Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, AL, USA
^r Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
^s Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Herat Center, Rigshospitalet, Copenhagen, Denmark

^⁎Corresponding author. Department of Pulmonary Diseases, AA11 University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700, RB, Groningen, the Netherlands.Department of Pulmonary DiseasesAA11 University Medical Center GroningenUniversity of GroningenPO Box 30.0019700RBGroningenthe Netherlands

Abstract

Bronchoscopic lung volume reduction treatment with Zephyr one-way valves is an effective guideline-based treatment option for patients with severe emphysema and hyperinflation. However, in some cases the treatment response is less than anticipated or there might be a loss of initial treatment effect.

Reasons for the lack of response can include incorrect assessment of collateral ventilation, improper valve placement, or patient related factors. Loss of initial benefit can be due to granulation tissue formation and subsequent valve dysfunction, or there may be side effects such as excessive coughing or infectious problems.

Careful follow-up after treatment with valves is important and evaluation with a CT scan and/or bronchoscopy is helpful if there is no improvement after treatment or loss of initial benefit. This paper aims to describe the most important causes and provide a strategy of how to approach and manage these patients.

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Highlights

•	BLVR with endobronchial valves is an important treatment option in carefully selected patients with severe emphysema.
•	With wide adoption of this procedure, physicians require a systematic approach to troubleshoot when outcomes are not optimal.
•	Evaluation with CT-scan and/or bronchoscopy is helpful when there is lack of response or loss of initial benefit.
•	If there is no initial effect after treatment, this may be due to presence of collateral ventilation or displaced valves.
•	Loss of effect due to valve dislocation or granulation tissue formation can be treated with valve removal and replacement.

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Keywords : COPD, Bronchoscopic lung volume reduction, Bronchoscopy, Endobronchial valves, Granulation tissue, Pneumothorax

Plan

Introduction

Definition of response

Follow-up after treatment

No initial treatment effect

Loss of initial effect

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Article 107639- juin 2024 Retour au numéro

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Optimizing clinical outcomes for bronchoscopic lung volume reduction with Zephyr® valves - 20/05/24

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