• Franziska C Trudzinski, Anna J Höink, Daniela Leppert, Sebastian Fähndrich, Heinrike Wilkens, Thomas P Graeter, Frank Langer, Robert Bals, Peter Minko, and Philipp M Lepper.
• Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center, Homburg, Germany.
• Respiration. 2016 Jan 1; 92 (4): 258-265.

BackgroundPatients with a forced expiratory volume in 1 s (FEV1) below 20% of the predicted normal values (pred.) and either homogeneous emphysema or low diffusing capacity for carbon monoxide (DLCO) have a high risk for adverse events including death when undergoing surgical lung volume reduction.ObjectivesWe hypothesized that selected patients can benefit from endoscopic lung volume reduction (eLVR) despite a very low FEV1.MethodsThis study is a retrospective analysis of consecutive patients with severe airflow obstruction, an FEV1 ≤20% of pred., and low DLCO who were treated by eLVR with endobronchial valves (EBV) between June 2012 and January 2015. Pre- and postinterventional lung function parameters, the 6-min walking test (6-MWT) distance, adverse events, and follow-up were recorded.ResultsIn 20 patients, there was an overall improvement in lung function with an increase in FEV1 (16.97-21.03% of pred.) and a decrease in residual volume (322-270% of pred.) and total lung capacity (144-129.06% of pred.). The 6-MWT distance improved (from 239 ± 77 to 267± 97 m overall, and from 184 ± 50 to 237 ± 101 m if patients developed an atelectasis of the target lobe). Pneumothorax occurred in 5 of the 20 patients (25%). 30-day mortality was 0%, and all patients survived to discharge.ConclusionsThe patients benefitted moderately from EBV treatment despite an initially low FEV1. Some patients improved remarkably. EBV treatment in patients with an FEV1 ≤20% of pred. is generally feasible and safe. The greatest risk is pneumothorax with prolonged chest tube duration.© 2016 S. Karger AG, Basel.

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