PMID- 30450237
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220330
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 10
IP  - Suppl 27
DP  - 2018 Oct
TI  - Complications related to endoscopic lung volume reduction for emphysema with 
      endobronchial valves: results of a multicenter study.
PG  - S3315-S3325
LID - 10.21037/jtd.2018.06.69 [doi]
AB  - BACKGROUND: Despite bronchoscopic lung volume reduction (BLVR) with valves is a 
      minimally invasive treatment for emphysema, it can associate with some 
      complications. We aimed at evaluating the rate and type of complications related 
      to valve treatment and their impact on clinical outcomes. METHODS: It is a 
      retrospective multicenter study including all consecutive patients with severe 
      heterogeneous emphysema undergoing BLVR with endobronchial valve treatment and 
      developed any complications related to this procedure. The type of complication, 
      the time of onset, the treatment required and the out-come were evaluated. 
      Response to treatment was assessed according to the minimal clinically important 
      difference (MCID) as follows: an improvement of >/=15% in forced expiratory volume 
      in one second (FEV(1)); of -8% in residual volume (RV); of >/=26 m in 6-minnute 
      walking distance (6MWD); and of >/=4 points on the St. George's Respiratory 
      Questionnaire (SGRQ). Target lobe volume reduction (TLVR) >/=350 mL was considered 
      significant. RESULTS: One hundred and seven out of 423 (25.3%) treated patients 
      had complications related to valve treatment including pneumothorax (17.3%); 
      pneumonia (1.7%), chronic obstructive pulmonary disease (COPD) exacerbation 
      (0.9%), respiratory failure (1.4%), valve migration (2.1%), and hemoptysis 
      (1.9%). In all cases complications resolved with appropriate treatment including 
      removal of valves in 21/107 cases (19.6%). Patients with TLVR >/=350 mL (n=64) vs. 
      those <350 mL (n=43) had a statistically significant higher improvement in FEV(1) 
      (19.0%+/-3.9% vs. 3.0%+/-0.9%; P=0.0003); in RV (-10.0%+/-4.8% vs. -4.0%+/-2.9%; 
      P=0.002); in 6MWD (33.0+/-19.0 vs. 12.0+/-6.3 metres; P=0.001); and in SGRQ 
      (-15.0+/-2.9 vs. -8.0+/-3.5 points; P=0.01). Only patients with TLVR >/=350 mL met or 
      exceeded the MCID cut-off criteria for FEV(1) (19.0%+/-3.9%), RV (-10.0%+/-4.8%), 
      6MWT (33.0+/-19.0 metres), and SGQR (-15.0+/-2.9 points). Five patients (1.2%) died 
      during follow-up for causes not related to valves treatment neither to any of the 
      complications described. CONCLUSIONS: Valve treatment is a safe and reversible 
      procedure. The presence of complications seems not to have a significant impact 
      on clinical outcome in patients with lobar atelectasis. Due to poor clinical 
      conditions and possible complications, BLVR should be performed in high volume 
      centers with a multidisciplinary approach.
FAU - Fiorelli, Alfonso
AU  - Fiorelli A
AD  - Thoracic Surgery Unit, Universita della Campania "Luigi Vanvitelli", Naples, 
      Italy.
FAU - D'Andrilli, Antonio
AU  - D'Andrilli A
AD  - Thoracic Surgery Unit, Universita La Sapienza, Sant'Andrea Hospital, Rome, Italy.
FAU - Bezzi, Michela
AU  - Bezzi M
AD  - Interventional Pneumology Unit, Policlinico Firenze, Florence, Italy.
FAU - Ibrahim, Mohsen
AU  - Ibrahim M
AD  - Thoracic Surgery Unit, Universita La Sapienza, Sant'Andrea Hospital, Rome, Italy.
FAU - Anile, Marco
AU  - Anile M
AD  - Thoracic Surgery Unit, Universita La Sapienza, Policlinico Hospital, Rome, Italy.
FAU - Diso, Daniele
AU  - Diso D
AD  - Thoracic Surgery Unit, Universita La Sapienza, Policlinico Hospital, Rome, Italy.
FAU - Cusumano, Giacomo
AU  - Cusumano G
AD  - Thoracic Surgery Unit, Policlinico Vittorio Emanuele Hospital, Catania, Italy.
FAU - Terminella, Alberto
AU  - Terminella A
AD  - Thoracic Surgery Unit, Policlinico Vittorio Emanuele Hospital, Catania, Italy.
FAU - Luzzi, Valentina
AU  - Luzzi V
AD  - Interventional Pneumology Unit, Policlinico Firenze, Florence, Italy.
FAU - Innocenti, Margherita
AU  - Innocenti M
AD  - Interventional Pneumology Unit, Policlinico Firenze, Florence, Italy.
FAU - Novali, Mauro
AU  - Novali M
AD  - Interventional Pneumology Unit, Spedili Civili Brescia, Brescia, Italy.
FAU - Carelli, Emanuele
AU  - Carelli E
AD  - Thoracic Surgery Unit, Universita della Campania "Luigi Vanvitelli", Naples, 
      Italy.
FAU - Freda, Chiara
AU  - Freda C
AD  - Thoracic Surgery Unit, Universita della Campania "Luigi Vanvitelli", Naples, 
      Italy.
FAU - Natale, Giovanni
AU  - Natale G
AD  - Thoracic Surgery Unit, Universita della Campania "Luigi Vanvitelli", Naples, 
      Italy.
FAU - Peritore, Valentina
AU  - Peritore V
AD  - Thoracic Surgery Unit, Universita La Sapienza, Sant'Andrea Hospital, Rome, Italy.
FAU - Poggi, Camilla
AU  - Poggi C
AD  - Thoracic Surgery Unit, Universita La Sapienza, Policlinico Hospital, Rome, Italy.
FAU - Failla, Giuseppe
AU  - Failla G
AD  - Interventional Pneumology Unit, Ospedale Civico Palermo, Palermo, Italy.
FAU - Basile, Marco
AU  - Basile M
AD  - Interventional Pneumology Unit, Ospedale Civico Palermo, Palermo, Italy.
FAU - Mazzucca, Emilia
AU  - Mazzucca E
AD  - Interventional Pneumology Unit, Ospedale Civico Palermo, Palermo, Italy.
FAU - Conforti, Serena
AU  - Conforti S
AD  - Thoracic Surgery Unit, Ospedale Niguarda, Milan, Italy.
FAU - Serra, Nicola
AU  - Serra N
AD  - Department of Pediatrics, University Federico II of Naples, Naples, Italy.
FAU - Torre, Massimo
AU  - Torre M
AD  - Thoracic Surgery Unit, Ospedale Niguarda, Milan, Italy.
FAU - Venuta, Federico
AU  - Venuta F
AD  - Thoracic Surgery Unit, Universita La Sapienza, Policlinico Hospital, Rome, Italy.
FAU - Rendina, Erino Angelo
AU  - Rendina EA
AD  - Thoracic Surgery Unit, Universita La Sapienza, Sant'Andrea Hospital, Rome, Italy.
FAU - Santini, Mario
AU  - Santini M
AD  - Thoracic Surgery Unit, Universita della Campania "Luigi Vanvitelli", Naples, 
      Italy.
FAU - Andreetti, Claudio
AU  - Andreetti C
AD  - Thoracic Surgery Unit, Universita La Sapienza, Sant'Andrea Hospital, Rome, Italy.
LA  - eng
PT  - Journal Article
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC6204336
OTO - NOTNLM
OT  - Zephyr endo-bronchial valves
OT  - bronchoscopic lung volume reduction (BLVR)
OT  - emphysema
COIS- Conflicts of Interest: The authors have no conflicts of interest to declare.
EDAT- 2018/11/20 06:00
MHDA- 2018/11/20 06:01
PMCR- 2018/10/01
CRDT- 2018/11/20 06:00
PHST- 2018/11/20 06:00 [entrez]
PHST- 2018/11/20 06:00 [pubmed]
PHST- 2018/11/20 06:01 [medline]
PHST- 2018/10/01 00:00 [pmc-release]
AID - jtd-10-S27-S3315 [pii]
AID - 10.21037/jtd.2018.06.69 [doi]
PST - ppublish
SO  - J Thorac Dis. 2018 Oct;10(Suppl 27):S3315-S3325. doi: 10.21037/jtd.2018.06.69.