Real-Time Invasive Hemodynamic Changes During Endobronchial Valve Therapy in Advanced Emphysema: A Prospective Case Series

Pulmonary hypertension (PH) in advanced emphysema is associated with worse outcomes and often prompts caution or exclusion from bronchoscopic lung volume reduction. The immediate pulmonary hemodynamic response to endobronchial valve (EBV) deployment has not been characterized using invasive measurements obtained during implantation. We performed a prospective single-center physiological case series of four consecutive patients undergoing clinically indicated EBV therapy with concurrent right heart catheterization and continuous systemic arterial pressure monitoring. Hemodynamics were sampled at end-expiration at four predefined timepoints: pre-general anesthesia (pre-GA), GA pre-valve, GA post-valve, and post-extubation once awake and hemodynamically stable. Cardiac output was estimated by the indirect Fick method using an assumed oxygen consumption. All patients met hemodynamic criteria for PH with a pre-capillary profile at baseline. In the prespecified GA comparison (pre-valve to post-valve), mean pulmonary artery pressure (mPAP) decreased in all four patients (-10% to -61%). In the prespecified awake comparison (pre-GA to post-extubation), mPAP decreased in all four (-33% to -58%), with post-extubation mPAP < 20 mmHg in three patients. Estimated pulmonary vascular resistance decreased in three under GA (-42% to -90%) and in all four in the awake comparison (-47% to -96%); pulmonary arterial compliance increased in all four. Real-time invasive hemodynamic assessment during EBV implantation was feasible in this four-patient case series and showed descriptive, hypothesis-generating reductions in pulmonary vascular load in selected patients with advanced emphysema and baseline pre-capillary PH.