Department of Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.
Int J Chron Obstruct Pulmon Dis. 2023 May 19;18:933-943. doi: 10.2147/COPD.S408674. eCollection 2023.
Up to 41% of patients with endobronchial valve implantation need revision bronchoscopies and valve replacements most likely due to valve dysfunction or lack of benefit. So far, no data is available whether valve replacements lead to the desired lobar volume reduction and therapy benefit.
We conducted a single-center retrospective analysis of patients with endobronchial valve implantation and at least one valve replacement. Indications and number of revision bronchoscopies and valve replacements were evaluated. Therapy benefit regarding lung function and exercise capacity as well as development of complete lobar atelectasis was investigated and possible predictors identified.
We identified 73 patients with 1-12 revision bronchoscopies and 1-5 valve replacements. The main indication for revision bronchoscopy in this group was lack of therapy benefit (44.2%). Lung function and exercise capacity showed improvements in about one-third of patients even years after the initial implantation. A total of 26% of all patients showed a complete lobar atelectasis at the end of the observation period, 56.2% had developed lung volume reduction. The logistic regression revealed the development of a previous complete lobar atelectasis as predictor for a complete lobar atelectasis at final follow-up. Oral cortisone long-term therapy was also shown as predictive factor. The probability for a final complete lobar atelectasis was 69.2% if a lobar atelectasis had developed before.
Valve replacements are more likely to be beneficial in patients who develop a re-aeration of a previous lobar atelectasis following valve implantation. Every decision for revision bronchoscopy must be taken carefully.
多达 41%的支气管内瓣膜植入患者需要进行修订支气管镜检查和瓣膜更换，最有可能的原因是瓣膜功能障碍或缺乏获益。到目前为止，尚无数据表明瓣膜更换是否会导致所需的肺叶体积减少和治疗获益。
我们对接受支气管内瓣膜植入术且至少进行过一次瓣膜更换的患者进行了单中心回顾性分析。评估了修订支气管镜检查和瓣膜更换的适应证和数量。研究了治疗对肺功能和运动能力的获益，以及完全性肺叶塌陷的发展情况，并确定了可能的预测因素。
我们共纳入 73 例患者，这些患者共进行了 1-12 次修订支气管镜检查和 1-5 次瓣膜更换。在该组患者中，修订支气管镜检查的主要适应证是缺乏治疗获益（44.2%）。即使在初始植入多年后，约三分之一的患者的肺功能和运动能力仍有所改善。在观察期末，所有患者中有 26%出现了完全性肺叶塌陷，56.2%发生了肺容积减少。逻辑回归显示，先前发生完全性肺叶塌陷是最终随访时发生完全性肺叶塌陷的预测因素。长期口服皮质激素治疗也被证明是一个预测因素。如果在之前发生过肺叶塌陷，那么最终发生完全性肺叶塌陷的概率为 69.2%。
在支气管内瓣膜植入后再次出现先前肺叶复张的患者中，瓣膜更换更有可能有益。每次进行修订支气管镜检查的决定都必须谨慎做出。
