Survival after endoscopic valve therapy in patients with severe emphysema
Daniela Gompelmann1,4, Nicola Benjamin1, Elena Bischoff1, Hans Hoffmann2, Claus-Peter Heussel3,4, Felix J.F. Herth1,4 and Ralf Eberhardt1,4
1Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany, 2Thoracic Surgery, Thoraxklinik at University of Heidelberg, Heidelberg, Germany, 3Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany, 4Translational Lung Research Center of Heidelberg, German Center for Lung Research, Heidelberg, Germany
Objectives: Endoscopic valve therapy leads to an improvement of lung function, exercise tolerance and quality of life in emphysema patients. Only few data exist on the long-term outcome. This analysis evaluated the impact of valve therapy on the survival of COPD patients.
Methods: From 2005-2013, 449 patients (mean age 64 years, 54% male) with emphysema underwent valve therapy. Patients were followed for a mean time of 37.3±21.3 months. 128 patients (29%) developed complete lobar atelectasis, whereby 34 out of these also experienced pneumothorax; in 50 patients (11%) pneumothorax without lobar atelectasis and in 261 patients (58%) only target lobe volume reduction or no volume change were observed. Baseline of survival was set as the date of first valve implantation.
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Results: Patients with and without atelectasis showed similar characteristics. Baseline FEV1%, RV(l), TLC(l) and TLCO(%) were significantly better in the atelectasis group, however the difference was not clinically relevant (FEV1 32±8% vs. 30±9%, RV 5.4±1.2L vs. 5.8±1.4L, TLC 7.9±1.6L vs. 8.2±1.7L, TLCO 32±12% vs. 30±11%; all p<0.05). Patients with lobar atelectasis had a significant survival benefit compared to patients without atelectasis (p=0.009; 5-year survival rate 63.5% vs. 43.9%). The advent of pneumothorax in 84 patients did not influence the survival (p=0.52).
Conclusions: Lobar atelectasis following endoscopic valve therapy is associated with a survival benefit.