Bronchoscopic Lung Volume Reduction with Valves and Coils. A Network Meta-analysis.

Area of Science:

• Pulmonology
• Medical Devices
• Interventional Pulmonology

Background:

• Advanced emphysema treatment often involves bronchoscopic lung volume reduction using coils or endobronchial valves.
• Device selection depends on emphysema characteristics and collateral ventilation, but head-to-head comparisons are lacking.

Purpose of the Study:

• To conduct a network meta-analysis comparing endobronchial valves and coils for bronchoscopic lung volume reduction.
• To evaluate device efficacy in patients with heterogeneous emphysema without collateral ventilation (CV) and in those with mixed homogeneous/heterogeneous emphysema.

Main Methods:

• A systematic search of PubMed and Web of Science identified randomized active comparator trials up to January 20, 2020.
• Network meta-analysis was performed using the "netmeta" package in R.

Main Results:

• In heterogeneous emphysema without CV, both Zephyr and Spiration valves improved FEV1 and SGRQ scores similarly; Zephyr valves also improved 6-minute walk distance (6MWD).
• In mixed emphysema types, Zephyr valves and coils improved FEV1, SGRQ, and 6MWD compared to control, with Zephyr valves showing the greatest 6MWD improvement.
• Both interventions were associated with pneumothorax but not COPD exacerbation.

Conclusions:

• Zephyr and Spiration valves are equally effective for FEV1 and SGRQ improvement in heterogeneous emphysema without CV.
• Zephyr valves demonstrate relative superiority over coils in improving 6MWD for patients with mixed homogeneous and heterogeneous emphysema.