Consolidating Lung Volume Reduction Surgery After Endoscopic Lung Volume Reduction Failure

Area of Science:

• Pulmonary Medicine
• Thoracic Surgery
• Interventional Pulmonology

Background:

• Endoscopic lung volume reduction (ELVR) using valves is effective for severe emphysema with low collateral ventilation.
• Long-term therapy failure can occur despite initial improvements.
• Surgical lung volume reduction (LVRS) is explored as a salvage therapy.

Purpose of the Study:

• To evaluate the feasibility and efficacy of LVRS after ELVR failure.
• To determine if LVRS can reestablish clinical improvements post-ELVR failure.

Main Methods:

• Retrospective single-center analysis of patients undergoing LVRS post-ELVR failure (2010-2015).
• Analysis of pulmonary function (FEV1, RV), exercise capacity (6MWD), and dyspnea (mMRC) 90 days post-procedures.
• Comparison of outcomes between ELVR and subsequent LVRS.

Main Results:

• LVRS was performed in 20 patients, primarily via lower lobectomy (90%).
• 90-day mortality was 5%; no 30-day mortality.
• Significant improvements observed in FEV1 (+27.5%), RV (-21.0%), 6MWD (+56 m), and mMRC (-1.8 points) in 19 patients.

Conclusions:

• Consolidating LVRS by lobectomy is feasible after prior ELVR failure.
• This approach leads to significant symptom relief and improved lung function.