Valve placement on par with surgery in emphysema: study

Interventional procedures

By Selina Wellbelove

12 Sep 2022

Bronchoscopic lung volume reduction (BVLR) is as effective as lung volume reduction surgery (LVRS) in patients with emphysema, with both techniques resulting in similar improvements in lung function, according to research published at ERS 2022.

Findings of the study, which compared these procedures for the first time, will be important for clinicians and patients in guiding decision-making around which treatment option to choose when both are suitable, Sarah Buttery, a research physiotherapist and PhD candidate at the National Heart and Lung Institute, Imperial College London (UK), told delegates.

“Bronchoscopic lung volume reduction is a less invasive option and is thought to be ‘less risky’ but, until now, there has not been substantial research to support this”, she noted.

In the CELEB trial, the UK research team randomised 88 patients (average age of 64 years) typically representative an LVR cohort to receive either LVRS (n = 4) or BLVR (n = 47), with subsequent follow-up for one year.

Patients’ response to treatment was measured using the iBODE score, which encompasses BMI, airflow obstruction, dyspnoea and exercise capacity.

Results showed that both groups improved to a similar extent after 12 months’ treatment, with neither the improvement in the iBODE score (LVRS: -1.10, BLVR: -0.82, P = 0.54) nor any of its individual components showing a significant difference (BMI: P = 0.16, FEV1%: P = 0.11, dyspnoea score: P = 0.19; and ISWT (m): P = 0.09).

RV% predicted as a measure of treatment efficacy was also similar between the two groups, and both exceeded the minimal clinically important difference of a drop of 6.1% from baseline, showing RV% predicted of -36.1 for surgery and -30.5 for valve placement (P = 0.91) after 12 months.

Also, there was no difference in survival between the two treatment groups, with one death in each treatment arm at 12 months.

Going forward, larger studies will need to assess whether it is possible to identify patients who respond particularly well to one approach or the other, as well as the cost benefit of each.

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