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J Thorac Cardiovasc Surg 2007;133:65-73
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

A multicenter trial of an intrabronchial valve for treatment of severe emphysema

^a Division of Cardiothoracic Surgery, the University of Washington, Seattle, Wash
^b Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
^c Division of Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
^d Division of Pulmonary Medicine, the University of Pennsylvania, Philadelphia, Pa
^e Division of Pulmonary Medicine, North Shore University Hospital, Manhasset, NY
^f Spiration, Inc, Redmond, Wash
^g Division of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.

Read at the Thirty-first Annual Meeting of the Western Thoracic Surgical Association, Victoria, British Columbia, Canada, June 22–25, 2005.

Received for publication October 18, 2005; revisions received May 30, 2006; accepted for publication June 7, 2006.

^_* Address for reprints: Douglas E. Wood, MD, University of Washington, Box 356310, 1959 NE Pacific, AA-115, Seattle, WA 98195-6310. (Email: dewood{at}u.washington.edu).

OBJECTIVES: Minimally invasive endoscopic treatment of emphysema could provide palliation with less risk than lung volume reduction surgery and offer therapy to patients currently not considered for lung volume reduction surgery. The Intrabronchial Valve is used to block bronchial airflow in the most emphysematous areas of lung.

METHODS: Patients with severe chronic obstructive pulmonary disease and heterogeneous upper lobe–predominant emphysema were eligible. Patients underwent flexible bronchoscopic placement of valves into segmental or subsegmental airways in both upper lobes. Outcomes assessed over a minimum of 6 months of follow-up included the safety, feasibility, tolerance, and success of valve placement; health-related quality of life; exercise capacity; pulmonary function; and gas exchange.

RESULTS: Five centers treated 30 patients. Patient follow-up ranged from 1 to 12 months. A mean of 6.1 valves were placed per patient. Valves were positioned by means of flexible bronchoscopy in 99% of desired airways, and the procedure duration ranged from 15 to 125 minutes (mean, 65 minutes). Hospital discharge occurred within 2 days in 27 of 30 patients. There were no deaths or episodes of valve migration, tissue erosion, or significant bleeding. Eighty-three percent of patients had no adverse events judged probably or definitely related to the device. Patients experienced significant improvement in health-related quality of life, although the physiologic and exercise outcomes did not show statistically significant improvements.

CONCLUSIONS: These first multicenter results with the Intrabronchial Valve demonstrate significant improvements in health-related quality of life and acceptable safety, ease of use, and procedural complication rates. The valve might be a safer and less-invasive alternative to surgical therapy for patients with severe emphysema.

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