Current Thoracic Surgery 2017 , Vol 2 , Issue 1
Endoscopic lung volume reduction in chronic obstructive airway disease using one-way valves
Konstantina Kontogianni1,Ralf Eberhardt1
1Department of Pulmonology and Critical Care Medicine, Heidelberg University, Heidelberg, Germany DOI : 10.26663/cts.2017.0009 Chronic obstructive airway disease (COPD) is a progressive, irreversible and debilitating disease causing lung hyperinflation. Apart from smoking cessation and conventional medical treatment, lung volume reduction surgery (LVRS) has been used for several years but it involves a major thoracic surgery with high incidence of postoperative complications. In the past decade, different approaches of minimally invasive endoscopic lung volume reduction (ELVR) have been developed which differ in indication, mechanism of action, reversibility and are divided into two groups: blocking and non-blocking devices.

The endobronchial valves belong to the group of blocking devices available and have the largest series of treated patients. These one way valves are used to occlude the most emphysematous and hence destroyed lobe of the lung. Two different types of valves are available on the market: endobronchial valves (EBV, Zephyr valves) and intrabronchial valves (IBV, Spiration valves). They differ in shape but have a similar mechanism of action.

In order to improve the outcome of the ELVR using valves, dedicated screening involving pulmonary function and exercise capacity testing as well as qualitative and quantitative CT analysis and perfusion scan are necessary. Numerous studies in the past years have shown the efficacy and complications following valve therapy. It has been demonstrated that patients with complete fissures show a more pronounced benefit and a significant target lobe volume reduction. Furthermore, unilateral implantation aiming at obtaining complete lobar occlusion has been more effective than the bilateral incomplete treatment. Regarding possible complications, apart from pneumothorax, COPD exacerbations, hemoptysis and valve migrations have been reported.

Summarizing, in comparison to LVRS, ELVR using valves is a less invasive alternative with the opportunity to improve shortness of breath, exercise capacity, and quality of life in the patients, who have reached the end of their conventional treatment options. Keywords : emphysema, endoscopic lung volume reduction, valve therapy