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* From the Departments of Respiratory Medicine (Drs. Snell, Williams, and Borrill, and Ms. Holsworth), Radiology (Dr. Thomson), and Nuclear Medicine (Dr. Kalff), Alfred Hospital and Monash University, Prahran; and the Department of Surgery (Dr. Smith), Monash University, Clayton, VIC, Australia.
Correspondence to: Gregory Snell, MD, Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, 3004, Australia; e-mail: g.snell{at}alfred.org.au
Study objectives: Significant morbidity and mortality offset the benefits of lung volume reduction surgery (LVRS) for emphysema. By contributing to distal lung collapse, bronchoscopic placement of valved prostheses has the potential to noninvasively replicate the beneficial effects of LVRS. The purpose of this study was to investigate the safety and feasibility of placing valves in segmental airways of patients with emphysema.
Design: Case series.
Setting: Tertiary hospital, severe airways disease clinic.
Patients: Ten patients aged 51 to 69 years with apical emphysema and hyperinflation, otherwise suitable for standard LVRS. Mean preoperative FEV1 was 0.72 L (19 to 46% predicted), and 6-min walk distance was 340 m (range, 245 to 425 m).
Intervention: Apical, bronchoscopic, segmental airway placement of one-way valves (silicone-based Nitinol bronchial stent; Emphasys Medical; Redwood City, CA) under general anesthesia. Placement was over a guidewire under bronchoscopic and fluoroscopic control.
Results: Four to 11 prostheses per patient took 52 to 137 min to obstruct upper-lobe segments bilaterally. Inpatient stay was 1 to 8 days. No major complications were seen in the 30-day study period. Minor complications included exacerbation of COPD (n = 3), asymptomatic localized pneumothorax (n = 1), and lower-lobe pneumonia (day 37; n = 1). Symptomatic improvement was noted in four patients. No major change in radiologic findings, lung function, or 6-min walk distance was evident at 1 month, although gas transfer improved from 7.47 ± 2.0 to 8.26 ± 2.6 mL/min/mm Hg (p = 0.04) and nuclear upper-lobe perfusion fell from 32 ± 10 to 27 ± 9% (mean ± SD) [p = 0.02].
Conclusion: Bronchoscopic prostheses can be safely and reliably placed into the human lung. Further study is needed to explore patient characteristics that determine symptomatic efficacy in a larger patient cohort.
Key Words: bronchoscopy • emphysema • stent
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