Sebastian Mang1,2, Niklas Huss1,2, Hans-Joachim Schäfers2,3, Holger Wehrfritz1,2, Alexander Massmann2,4, Christian Lensch1,2, Frank Langer2,3, Frederik Seiler1,2, Robert Bals1,2, Philipp M Lepper1,2. 1. Department of Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University Hospital, Homburg/Saar,Germany. 2. Saarland University, Saarbrücken, Germany. 3. Department of Thoracic- and Cardiovascular Surgery, Saarland University Hospital, Homburg/Saar, Germany. 4. Department of Diagnostic and Interventional Radiology, Saarland University Hospital, Homburg/Saar, Germany.
Abstract
OBJECTIVES: Patients with chronic obstructive pulmonary disease and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol coil-based ELVR techniques have been ambiguous. The analysis was done to analyse outcomes of ELVR with nitinol coils in patients with severe pulmonary emphysema. METHODS: From September 2013 to November 2014, our centre performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anaesthesia. Twelve out of 29 patients received staged contralateral treatments up to 112 days later to avoid bilateral pneumothorax. Lung function and 6-min walking distance were assessed 1 week prior, 1 week after as well as 6-12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort. RESULTS: While coil-based ELVR led to significant short-term improvement of vital capacity (VC, +0.14 ± 0.39 l, P = 0.032) and hyperinflation (Δ residual volume/total lung capacity -2.32% ± 6.24%, P = 0.022), no significant changes were observed in 6-min walking distance or forced expiratory volume in 1 s. Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in forced expiratory volume in 1 s or residual volume after 6 months. Adverse events included haemoptysis (40%) and pneumothorax (3.4%), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment. CONCLUSIONS: ELVR with coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.
OBJECTIVES: Patients with chronic obstructive pulmonary disease and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol coil-based ELVR techniques have been ambiguous. The analysis was done to analyse outcomes of ELVR with nitinol coils in patients with severe pulmonary emphysema. METHODS: From September 2013 to November 2014, our centre performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anaesthesia. Twelve out of 29 patients received staged contralateral treatments up to 112 days later to avoid bilateral pneumothorax. Lung function and 6-min walking distance were assessed 1 week prior, 1 week after as well as 6-12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort. RESULTS: While coil-based ELVR led to significant short-term improvement of vital capacity (VC, +0.14 ± 0.39 l, P = 0.032) and hyperinflation (Δ residual volume/total lung capacity -2.32% ± 6.24%, P = 0.022), no significant changes were observed in 6-min walking distance or forced expiratory volume in 1 s. Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in forced expiratory volume in 1 s or residual volume after 6 months. Adverse events included haemoptysis (40%) and pneumothorax (3.4%), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment. CONCLUSIONS: ELVR with coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.
Authors: Jorine E Hartman; Nick H T Ten Hacken; Karin Klooster; H Marike Boezen; Mathieu H G de Greef; Dirk-Jan Slebos Journal: Eur Respir J Date: 2012-03-22 Impact factor: 16.671
Authors: J D Cooper; E P Trulock; A N Triantafillou; G A Patterson; M S Pohl; P A Deloney; R S Sundaresan; C L Roper Journal: J Thorac Cardiovasc Surg Date: 1995-01 Impact factor: 5.209
Authors: Frank C Sciurba; Gerard J Criner; Charlie Strange; Pallav L Shah; Gaetane Michaud; Timothy A Connolly; Gaëtan Deslée; William P Tillis; Antoine Delage; Charles-Hugo Marquette; Ganesh Krishna; Ravi Kalhan; J Scott Ferguson; Michael Jantz; Fabien Maldonado; Robert McKenna; Adnan Majid; Navdeep Rai; Steven Gay; Mark T Dransfield; Luis Angel; Roger Maxfield; Felix J F Herth; Momen M Wahidi; Atul Mehta; Dirk-Jan Slebos Journal: JAMA Date: 2016 May 24-31 Impact factor: 56.272
Authors: Dirk-Jan Slebos; Joseph Cicenia; Frank C Sciurba; Gerard J Criner; Jorine E Hartman; Justin Garner; Gaëtan Deslée; Antoine Delage; Michael Jantz; Charles-Hugo Marquette; Charlie Strange; Umur Hatipoglu; Atul C Mehta; Adam S LaPrad; Gerald Schmid-Bindert; Felix J F Herth; Pallav L Shah Journal: Chest Date: 2019-02-21 Impact factor: 9.410
Authors: Alfred Fishman; Fernando Martinez; Keith Naunheim; Steven Piantadosi; Robert Wise; Andrew Ries; Gail Weinmann; Douglas E Wood Journal: N Engl J Med Date: 2003-05-20 Impact factor: 91.245
Authors: Bartolome R Celli; Claudia G Cote; Jose M Marin; Ciro Casanova; Maria Montes de Oca; Reina A Mendez; Victor Pinto Plata; Howard J Cabral Journal: N Engl J Med Date: 2004-03-04 Impact factor: 91.245