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Fiorelli A, Leonardi B, Messina G, Luzzi L, Paladini P, Catelli C, Minervini F, Kestenholz P, Teodonio L, D’Andrilli A, Rendina EA, Natale G. Lung Resection for Non-Small Cell Lung Cancer following Bronchoscopic Lung Volume Reduction for Heterogenous Emphysema. Cancers (Basel) 2024; 16:605. [PMID: 38339355 PMCID: PMC10854739 DOI: 10.3390/cancers16030605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment for emphysema. Lung cancer may be associated with emphysema due to common risk factors. Thus, a growing number of patients undergoing BLVR may develop lung cancer. Herein, we evaluated the effects of lung resection for non-small cell lung cancer in patients undergoing BLVR. The clinical data of patients undergoing BLVR followed by lung resection for NSCLC were retrospectively reviewed. For each patient, surgical and oncological outcomes were recorded to define the effects of this strategy. Eight patients were included in our series. In all cases but one, emphysema was localized within upper lobes; the tumor was detected during routine follow-up following BLVR and it did not involve the treated lobe. The comparison of pre- and post-BLVR data showed a significant improvement in FEV1 (29.7 ± 4.9 vs. 33.7 ± 6.7, p = 0.01); in FVC (28.5 ± 6.6 vs. 32.4 ± 6.1, p = 0.01); in DLCO (31.5 ± 4.9 vs. 38.7 ± 5.7, p = 0.02); in 6MWT (237 ± 14 m vs. 271 ± 15 m, p = 0.01); and a reduction in RV (198 ± 11 vs. 143 ± 9.8, p = 0.01). Surgical resection of lung cancer included wedge resection (n = 6); lobectomy (n = 1); and segmentectomy (n = 1). No major complications were observed and the comparison of pre- and post-operative data showed no significant reduction in FEV1% (33.7 ± 6.7 vs. 31.5 ± 5.3; p = 0.15) and in DLCO (38.7 ± 5.7 vs. 36.1 ± 5.4; p = 0.15). Median survival was 35 months and no cancer relapses were observed. The improved lung function obtained with BLVR allowed nonsurgical candidates to undergo lung resection for lung cancer.
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Affiliation(s)
- Alfonso Fiorelli
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Beatrice Leonardi
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Gaetana Messina
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
| | - Luca Luzzi
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Piero Paladini
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Chiara Catelli
- Lung Transplantation Unit, University of Siena, 53100 Siena, Italy; (L.L.); (P.P.); (C.C.)
| | - Fabrizio Minervini
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (F.M.); (P.K.)
| | - Peter Kestenholz
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (F.M.); (P.K.)
| | - Leonardo Teodonio
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Antonio D’Andrilli
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sapienza University, Sant’Andrea Hospital, 00189 Rome, Italy; (L.T.); (A.D.); (E.A.R.)
| | - Giovanni Natale
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (B.L.); (G.M.); (G.N.)
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Noro A, Natale G, Messina G, Leonardi B, Rainone A, Santini M, Fiorelli A. The Prediction of Fissure Integrity by Quantitative Computed Tomography Analysis. Thorac Cardiovasc Surg 2023; 71:573-581. [PMID: 35987193 DOI: 10.1055/s-0042-1755382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Incomplete interlobar fissure may increase the difficulty of thoracoscopic lobectomy. Herein, we compared the accuracy of visual versus quantitative analysis to predict fissure integrity in lung cancer patients undergoing thoracoscopic lobectomy and evaluated the effects of fissure integrity on surgical outcome. METHODS This was a single-center retrospective study including consecutive patients undergoing VATS (video-assisted thoracoscopic surgery) lobectomy for lung cancer. The target interlobar fissures were classified as complete or incomplete by visual and quantitative analysis. Using the intraoperative finding as the reference method, the diagnostic accuracy of the two methods to define fissure completeness (dependent variable) was calculated and statistically compared. Yet, we evaluated differences in postoperative outcomes between patients with complete and incomplete fissure integrity. RESULTS A total of 93 patients were included in the study; 33/93 (36%) presented complete fissure. Visual and quantitative analyses correctly identified complete fissure in 19/33 (57%) and 29/33 (88%) patients, respectively, and incomplete fissure in 56/60 (93%) and 58/60 (96%) patients, respectively. Quantitative analysis had better diagnostic accuracy than visual analysis (81 vs. 93%; p = 0.01). Patients with incomplete fissure compared with those with complete fissure had a higher conversion rate (6 vs. 13%; p = 0.43), higher persistent air leak rate (0/33 vs. 14/60; p = 0.03), and longer hospitalization (12.6 ± 3.8 vs. 7.1 ± 2.4 days; p = 0.01). CONCLUSION Quantitative analysis accurately predicted the fissures' integrity; it may be useful for selecting suitable cases for thoracoscopic lobectomy especially for surgeons with limited minimally invasive experience.
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Affiliation(s)
- Antonio Noro
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Gaetana Messina
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Beatrice Leonardi
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Anna Rainone
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli," Naples, Italy
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Patel M, Chowdhury J, Zhao H, Lu X, Roth S, Giovacchini CX, Wahidi MM, Criner G. Meta-analysis and Systematic Review of Bronchoscopic Lung Volume Reduction Through Endobronchial Valves in Severe Emphysema. J Bronchology Interv Pulmonol 2022; 29:224-237. [PMID: 35698281 PMCID: PMC9233031 DOI: 10.1097/lbr.0000000000000872] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pharmacologic therapeutics for advanced emphysema have limited benefit. Bronchoscopic lung volume reduction with endobronchial valves (EBVs) have reported improvements in lung function, breathlessness, and quality of life through randomized clinical trials, with less morbidity as comparted to Surgical Lung volume Reduction. We here present a Meta-analysis and systematic review of bronchoscopic lung volume reduction in advanced chronic obstructive lung disease patients. METHODS PubMed (NLM), Embase (Elsevier), and Web of Science (Clarivate Analytics) search was conducted using a combination of keywords and subject headings. The search was confined to the last 15 years and was completed on October 23, 2020. Only placebo-controlled randomized control trials of emphysema patients with EBV were included. Quality assessment was done by 2 independent reviewers. RESULTS Nine studies were included for the meta-analysis with a total number of 1383 patients of whom 888 received EBV and 495 standard of care (SOC) medications. Our Metanalysis show statistically significant improvement in forced expiratory volume in first second, percentage forced expiratory volume in first second, St. George's respiratory questionnaire, and 6-minute walk distance in EBV group compared with SOC. Residual volume had statistically significant reduction after EBV placement compared with SOC. These differences continued to be present during short-term (<=6 mo) and long-term follow-up (>=6 mo). These improvements were even higher when the EBV patients'. Collateral ventilation was negative/fissure was intact (CV-/FI >90%). The rate of hemoptysis and pneumothorax was higher in the EBV group compared with SOC, however, did not lead to increased fatal outcomes. CONCLUSION In conclusion, EBV has favorable effects on patients' outcomes in patients who have heterogeneous emphysema particularly with no collateral ventilation.
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Affiliation(s)
- Maulin Patel
- The University of Texas Health Science Center at Houston, Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Junad Chowdhury
- Inova Fairfax Medical Center, Medical Critical Care Services
| | - Huaqing Zhao
- Lewis Katz School of Medicine at Temple University, Department of Biomedical Education and Data Science
| | - Xiaoning Lu
- Lewis Katz School of Medicine at Temple University, Department of Biomedical Education and Data Science
| | - Stephanie Roth
- Temple University, Department of Biomedical & Research Services Librarian
| | | | - Momen M. Wahidi
- Duke University, Division of Pulmonary, Allergy and Critical Care Medicine
| | - Gerard Criner
- Temple University Hospital, Department of Thoracic Medicine, and Surgery
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Fiorelli A, Messina G, Santini M. Collateral ventilation effect after endoscopic recanalization of malignant stenosis. ARCHIVOS DE BRONCONEUMOLOGÍA 2022; 58:770. [DOI: 10.1016/j.arbres.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
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Green DB, Groner LK, Lee JJ, Shin J, Broncano J, Vargas D, Castro M, Shostak E. Overview of Interventional Pulmonology for Radiologists. Radiographics 2021; 41:1916-1935. [PMID: 34534017 DOI: 10.1148/rg.2021210046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Interventional pulmonology is a growing field specializing in minimally invasive procedures of the mediastinum, lungs, airways, and pleura. These procedures have both diagnostic and therapeutic indications and are performed for benign and malignant diseases. Endobronchial US has been combined with transbronchial needle aspiration to extend tissue sampling beyond the airways and into the lungs and mediastinum. Recent innovations extending the peripheral access of bronchoscopy include electromagnetic navigational bronchoscopy and thinner bronchoscopes. An important indication for therapeutic bronchoscopy is the relief of central airway obstruction, which may be severe and life threatening. Techniques for restoring patency of the central airways include mechanical debulking and multiple modalities for ablation, stent placement, and balloon bronchoplasty. Bronchoscopic lung volume reduction improves quality of life in certain patients with severe emphysema and is an important less invasive alternative to lung volume reduction surgery. Bronchial thermoplasty is likewise a nonpharmacologic treatment in patients with severe uncontrolled asthma. Many of these procedures have unique selection criteria that require precise evaluations at preprocedure imaging. Postprocedure imaging is also essential in determining outcome success and the presence of complications. Radiologists should be familiar with these procedures as well as the relevant imaging features in both planning and later surveillance. Evolving techniques that may become more widely available in the near future include robotic-assisted bronchoscopy, bronchoscopic transparenchymal nodule access, transbronchial cryobiopsy, ablation of early-stage cancers, and endobronchial intratumoral chemotherapy. An invited commentary by Wayne et al is available online. ©RSNA, 2021.
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Affiliation(s)
- Daniel B Green
- From the Departments of Radiology (D.B.G., L.K.G., J.S.) and Cardiothoracic Surgery (E.S.), Weill Cornell Medicine, 525 E 68th St, Box 141, New York, NY 10065; Departments of Medicine (J.J.L.) and Radiology (D.V.), University of Colorado, Aurora, Colo; Department of Radiology, Hospital San Juan de Dios, Córdoba, Spain (J.B.); and Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kan (M.C.)
| | - Lauren K Groner
- From the Departments of Radiology (D.B.G., L.K.G., J.S.) and Cardiothoracic Surgery (E.S.), Weill Cornell Medicine, 525 E 68th St, Box 141, New York, NY 10065; Departments of Medicine (J.J.L.) and Radiology (D.V.), University of Colorado, Aurora, Colo; Department of Radiology, Hospital San Juan de Dios, Córdoba, Spain (J.B.); and Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kan (M.C.)
| | - Jared J Lee
- From the Departments of Radiology (D.B.G., L.K.G., J.S.) and Cardiothoracic Surgery (E.S.), Weill Cornell Medicine, 525 E 68th St, Box 141, New York, NY 10065; Departments of Medicine (J.J.L.) and Radiology (D.V.), University of Colorado, Aurora, Colo; Department of Radiology, Hospital San Juan de Dios, Córdoba, Spain (J.B.); and Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kan (M.C.)
| | - James Shin
- From the Departments of Radiology (D.B.G., L.K.G., J.S.) and Cardiothoracic Surgery (E.S.), Weill Cornell Medicine, 525 E 68th St, Box 141, New York, NY 10065; Departments of Medicine (J.J.L.) and Radiology (D.V.), University of Colorado, Aurora, Colo; Department of Radiology, Hospital San Juan de Dios, Córdoba, Spain (J.B.); and Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kan (M.C.)
| | - Jordi Broncano
- From the Departments of Radiology (D.B.G., L.K.G., J.S.) and Cardiothoracic Surgery (E.S.), Weill Cornell Medicine, 525 E 68th St, Box 141, New York, NY 10065; Departments of Medicine (J.J.L.) and Radiology (D.V.), University of Colorado, Aurora, Colo; Department of Radiology, Hospital San Juan de Dios, Córdoba, Spain (J.B.); and Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kan (M.C.)
| | - Daniel Vargas
- From the Departments of Radiology (D.B.G., L.K.G., J.S.) and Cardiothoracic Surgery (E.S.), Weill Cornell Medicine, 525 E 68th St, Box 141, New York, NY 10065; Departments of Medicine (J.J.L.) and Radiology (D.V.), University of Colorado, Aurora, Colo; Department of Radiology, Hospital San Juan de Dios, Córdoba, Spain (J.B.); and Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kan (M.C.)
| | - Mario Castro
- From the Departments of Radiology (D.B.G., L.K.G., J.S.) and Cardiothoracic Surgery (E.S.), Weill Cornell Medicine, 525 E 68th St, Box 141, New York, NY 10065; Departments of Medicine (J.J.L.) and Radiology (D.V.), University of Colorado, Aurora, Colo; Department of Radiology, Hospital San Juan de Dios, Córdoba, Spain (J.B.); and Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kan (M.C.)
| | - Eugene Shostak
- From the Departments of Radiology (D.B.G., L.K.G., J.S.) and Cardiothoracic Surgery (E.S.), Weill Cornell Medicine, 525 E 68th St, Box 141, New York, NY 10065; Departments of Medicine (J.J.L.) and Radiology (D.V.), University of Colorado, Aurora, Colo; Department of Radiology, Hospital San Juan de Dios, Córdoba, Spain (J.B.); and Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kan (M.C.)
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Verga SR, Criner GJ. Device profile of the Zephyr endobronchial valve in heterogenous emphysema: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:823-832. [PMID: 34314290 DOI: 10.1080/17434440.2021.1957831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Emphysema affects millions of people; the underlying pathophysiology is hyperinflation due to destruction of lung parenchyma. The mainstay of treatment is medical therapy however there are two surgical treatment strategies approved by the FDA to reduce lung hyperinflation. First being lung volume reduction surgery (LVRS), which carries higher risk of mortality versus bronchoscopic lung volume reduction (BLVR). BLVR has reduced peri-operative morbidity without compromising improvement in post-bronchodilator forced expiratory volume 1s (FEV1) and patient-reported outcomes. The added benefit of BLVR is that older adults who have end-stage emphysema who otherwise would not be appropriate surgical candidates for LVRS or transplant have an alternative treatment option. AREAS COVERED This is a review paper focusing on Zephyr® endobronchial valves (EBV). Specifically, clinical outcomes of major trials, selection criteria, valve/deployment catheter features, description of procedure, discussing the Chartis™ Pulmonary Assessment System and StratX report, management of complications and discussing next steps in protocolizing post-EBV care. EXPERT OPINION The expert opinion section focuses on outcomes from the LIBERATE Trial and 1-yr post-hoc analysis. Further 5-year follow-up post Zephyr® EBV placement along with protocolization post-EBV placement are needed to minimize adverse events and/or be able to manage, especially with high risk of pneumothorax (PTX).
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Affiliation(s)
- Steven R Verga
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Wienker J, Karpf-Wissel R, Funke F, Taube C, Wälscher J, Winantea J, Maier S, Mardanzai K, Darwiche K. Predictive value of Chartis measurement for lung function improvements in bronchoscopic lung volume reduction. Ther Adv Respir Dis 2020; 14:1753466620932507. [PMID: 32615853 PMCID: PMC7339075 DOI: 10.1177/1753466620932507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Bronchoscopic lung volume reduction (BLVR) via valve
implantation can be achieved by targeting severely hyperinflated and
emphysematously destructed lung areas in patients with chronic obstructive
lung disease. Lack of collateral ventilation (CV) is important for good
outcomes with BLVR. CV can be measured using the catheter-based Chartis
system. The aim of this study was to evaluate the correlation between total
exhaled volume drained from the target lobe measured by Chartis and clinical
outcomes after BLVR in CV-negative patients. Methods: From January 2016 to March 2019, 60 patients were included in this
retrospective single-center analysis. Drained volume (TVol) measured by
Chartis was recorded and compared with lung function and physical
performance parameters. Outcome variables included the percentage change in
lung function [forced expiratory volume in 1 s (FEV1), residual
volume (RV), and inspiratory vital capacity (IVC)]. Secondary outcomes were
the degree of target lobe volume reduction (TLVR), change in 6-min walk
distance (6MWD), and change in chronic obstructive pulmonary disease (COPD)
assessment test (CAT) score. Results: Drained volume correlated significantly with post-BLVR change in
FEV1 (r = 0.663), IVC
(r = 0.611), RV (r = −0.368), and TLVR
(r = 0.635) (all p < 0.05). In
a priori-defined patient subgroups based on drained
volume [<100 ml (n = 19), 100−400 ml
(n = 33), and >400 ml (n = 8)]; mean
changes in FEV1 were 2.6%, 17.4%, and 51.3%; in RV were −3.9%,
−10.6%, and −23.8%; in IVC were −4.0%, 10.6%, and 62.4%; and in TLVR were
525 ml (39%), 1375 ml (73%) and 1760 ml (100%), respectively. There were no
significant correlations between absolute and percentage changes in 6MWD and
the CAT score. Lung volume reduction was diagnosed in 32 (53%) cases. Conclusion: Drained volume measured by the Chartis system correlated with functional
improvement in CV-negative patients undergoing BLVR. The reviews of this paper are available via the supplemental
material section.
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Affiliation(s)
- Johannes Wienker
- Department of Pneumology, Division of Interventional Pneumology, University Medicine Essen-Ruhrlandklinik, Tüschener Weg 40, Essen, NRW 45239, Germany
| | - Rüdiger Karpf-Wissel
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Faustina Funke
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Christian Taube
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Julia Wälscher
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Jane Winantea
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Sandra Maier
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Khaled Mardanzai
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
| | - Kaid Darwiche
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Nordrhein-Westfalen, Germany
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Fiorelli A, Cascone R, Natale G, Peritore V, Vanni C, Poggi C, Venuta F, Rendina EA, Santini M, Andreetti C. Cardio-Pulmonary Changes After Bronchoscopic Lung Volume Reduction with Endobronchial One-Way Valves. Lung 2020; 198:565-573. [PMID: 32266460 DOI: 10.1007/s00408-020-00351-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/30/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION To evaluate the cardio-pulmonary hemodynamics changes before and after valve treatment, and their correlation with lobe volume reduction. METHODS This retrospective multicentre study included consecutive patients undergoing bronchoscopic valve treatment for heterogeneous emphysema. In addition to standard functional evaluation, patients underwent cardiac evaluation by Doppler trans-thoracic echocardiography. The difference in respiratory and cardio-pulmonary hemodynamics indexes before and 3-month after the procedure, and their relationship with changes in lobar volume were evaluated. RESULTS Seventy-seven patients were included in the study; of these 13 (17%) presented pulmonary hypertension. Only patients with target lobar volume reduction ≥ 563 mL (n = 50) presented a significant improvement of forced expiratory volume in one second, residual volume, 6 min-walk test, and St. George's Respiratory Questionnaire score; a significant reduction of pulmonary artery pressure, and an improvement of left and right ventricle end-systolic volume; of left and right ventricle end-diastolic volume, and of left and right ventricle stroke volume. The change in residual volume was significantly correlated with changes in forced expiratory volume in one second (r = 0.68; p < 0.001); in 6 min-walk test (r = 0.71; p < 0.001); in St. George's Respiratory Questionnaire (r = 0.54; p < 0.001); in pulmonary artery pressure (r = 0.39; p = 0.001), in left (r = 0.28; p = 0.01) and right (r = 0.33; p = 0.002) ventricle end-systolic volume, in left (r = - 0.29; p = 0.008) and right (r = - 0.34; p = 0.007) end-diastolic volume, and in left (r = - 0.76; p = 0.009) and right (r = - 0.718; p = 0.001) ventricle stroke volume. CONCLUSION Bronchoscopic valve treatment seemed to have positive effects on cardio-pulmonary hemodynamics, and these changes were correlated with reductions of lobar volume.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Caserta, Italy.
| | - Roberto Cascone
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Valentina Peritore
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Camilla Vanni
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Camilla Poggi
- Thoracic Surgery Unit, Policlinico Hospital, University of Rome La Sapienza, Rome, Italy
| | - Federico Venuta
- Thoracic Surgery Unit, Policlinico Hospital, University of Rome La Sapienza, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Claudio Andreetti
- Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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